SYNDROMES_OF_LESIONS_AND_DISEASES_OF_THE_RESPIRATORY_SYSTEM_IN_CHILDREN.pptx

SYNDROMES_OF_LESIONS_AND_DISEASES_OF_THE_RESPIRATORY_SYSTEM_IN_CHILDREN

1. SYNDROMES OF LESIONS AND DISEASES OF THE RESPIRATORY SYSTEM IN CHILDREN

2. Respiratory Failure Syndrome Respiratory failure is a pathological syndrome , insufficiency of the function of external respiration , which leads to the development of hypoxemia - an insufficient amount of oxygen in the arterial blood . These are either any disturbances in gas exchange between the body and the external environment , or a pathological condition in which external respiration does not provide adequate gas exchange between atmospheric air and the blood of the pulmonary capillaries , or provides it by increasing ventilation and perfusion .

3. Respiratory Failure Causes 1. Defeat of the lower respiratory tract with obstruction symptoms ( stenosing laryngotracheitis , bronchitis, bronchial asthma, pneumonia, etc.); 2. collapse of the lungs during pneumothorax , compression of the respiratory parts by a tumor of the mediastinum , with aspiration of a foreign body, etc .; 3. Damage to the upper respiratory tract - swelling of the nasal passages and tongue , significant proliferation of the adenoids ; 4. Diseases of the nervous system with damage to the respiratory center ( encephalitis , meningitis , poliomyelitis , etc .), Pathology of the spinal cord with dysfunction of the respiratory muscles ( trauma , tetanus , etc .).

4. Respiratory failure There are several types of respiratory failure classifications : according to pathogenesis , according to the rate of development, according to the severity , according to the anatomical principle . The most common classification by pathogenesis is as follows : Ventilation ( hypercapnic ) - associated mainly with damage to the mechanical ventilation apparatus with hypoventilation , hypercapnia . Parenchymal ( hypoxemic ) - associated with damage to the lung parenchyma and impaired gas exchange , mainly in the area of ​​ the alveolar-arterial transition .

5. According to the length in time , acute and chronic respiratory failure are distinguished . Acute develops within minutes or days , chronic develops over several months or even years . According to the severity , the degree o f respiratory failure is distinguished depending on the gas composition of the blood : D egree of respiratory failure   РаО 2 SaO 2 Norm ≥80 ≥95 I 60–79 90–94 II 40–59 75–89 III ˂40 ˂75

6. According to the anatomical principle The level of the lesion system Example of Respiratory Failure of External Respiration   CNS and respiratory center Drug overdose , hypothyroidism , central apnea , cerebrovascular accident Neuromuscular system Guillain - Barr é syndrome , botulism , myasthenia gravis , disease Duchenne , weakness and fatigue of the respiratory muscles Chest Spine kyphoscoliosis , obesity , condition after thoracoplasty , pneumothorax , pleural effusion Respiratory  ways   Laryngospasm , laryngeal edema , foreign body, bronchial asthma pathways , Chronic Obstructive Pulmonary Disease , cystic fibrosis , obliterating bronchiolitis Alveoli   Pneumonia , Acute respiratory distress syndrome , atelectasis , alveolitis edema , pulmonary fibrosis , pulmonary sarcoidosis .

7. Pathogenesis Alveolar hypoventilation With all types of respiratory failure due to lack of oxygen in the blood and hypoxia , compensatory reactions of organs and tissues develop . Most often , erythrocytosis, hyperhemoglobinemia and an increase in the minute volume of blood circulation develop . In the initial stage of the disease , these reactions compensate for the symptoms of hypoxia . With significant disturbances in gas exchange , these reactions can no longer compensate for hypoxia and themselves become the causes of the development of pulmonary heart .

8. Obstructive respiratory failure Reasons for narrowing the lumen of the bronchi : • Bronchospasm , • Allergic edema , • Inflammatory edema , • Infiltration of the bronchial mucosa , • Blockage of the bronchi with sputum , • Sclerosis of the bronchial walls , • Destruction of the framework of the bronchial walls .

9. The main clinical manifestations

10. Obstructive respiratory failure Pallor of the skin or its grayish tint ( due to diffuse cyanosis ), Lengthening of exhalation , Participation in the respiration of auxiliary muscles , Signs of significant fluctuations in intrathoracic pressure [ collapse of the cervical veins , retraction of the intercostal spaces during inhalation , swelling of the intercostal spaces during exhalation ], An increase in the chest in anteroposterior size .

11. Restrictive respiratory failure Respiratory failure of the restrictive type is characterized by a limitation of the ability of the lung tissue to expand and collapse and occurs in exudative pleurisy , pneumothorax , pneumosclerosis , adhesions in the pleural cavity , limited mobility of the rib cage , kyphoscoliosis , and so on . Respiratory failure in these conditions develops due to the limitation of the maximum possible depth of inspiration .

12. Treatment The main task of the treatment of respiratory failure is to find and eliminate the main cause of respiratory failure , as well as the use of mechanical ventilation , if necessary . Treatment principles for acute respiratory failure The treatment of acute respiratory failure is based on dynamic observation of the patient's external respiration parameters , blood gas composition and acid-base state . The data obtained must be compared with the parameters of oxygen transport , the functions of the cardiovascular system and other organs .

13. General activities : • Give the correct position to the patient's body; • Fix the position of the head and chest ; • Physiotherapy on the chest area ; • Conducting anesthesia ; • Support for mechanical ventilation .

14. When indicating artificial ventilation of the lungs : • Use of respirators of various modifications ; • Maintaining optimal lung compliance ; • Creation of a minimum F i O 2 to maintain adequate P a O 2 ( not less than 60 mm hg ) and S a O 2 ( not less than 90%); • Ensuring minimum airway pressure during inspiration ; • Adequate hydration of the breathing gas .

15. Respiratory distress syndrome of newborns Respiratory distress syndrome of newborns ( synonyms : respiratory distress syndrome , hyaline membrane disease ) is a severe respiratory distress in premature infants due to immaturity of the lungs and primary surfactant deficiency . Usually formed in the prenatal and neonatal periods of the child's development. As a rule , the disease is recorded in premature babies (60% - at 28 weeks of gestation , 15-20% - at 32-36 weeks ). With rational and timely treatment of infants , mortality is approximately 1%.

16. Catarrhal-respiratory syndrome (CRS) Catarrhal-respiratory syndrome (CRS) is characterized by inflammation of the mucous membrane of the respiratory tract with overproduction of secretions and activation of local defense reactions . Clinical characteristics With inflammation of the mucous membrane above the vocal cords , symptoms of rhinitis , pharyngitis , tonsillitis occur ; below the vocal cords - laryngitis , tracheitis , epiglottitis , bronchitis , pneumonia .

17. Hyperthermic syndrome Hyperthermic syndrome in children is a violation of thermoregulation with a significant increase in body temperature and a concomitant inadequate response from the internal organs , in particular the cardiovascular and nervous systems . It is manifested by hyperthermia from 39.5 C ° and above , hemodynamic disturbances , signs of cerebral edema and acute multiple organ failure . Hyperthermic syndrome in children is a critical condition that threatens the life of a child . It develops more often in children under 6 years of age , much less often in adolescents . In the absence of timely diagnosis and treatment , the likelihood of death is high. The danger of the condition lies in the speed of its development.

18. Causes of hyperthermic syndrome in children Hyperthermic syndrome in children , like any increase in temperature of other etiology , is a protective reaction of the body, most often to an infectious agent ( bacteria , virus , etc .). Only in this case , the reaction is inadequate , with the involvement of many vital organs and systems in the pathogenesis .

19. Symptoms of hyperthermia syndrome in children

20. On physical examination , the pediatrician reveals tachycardia , rapid breathing , low blood pressure . In the general analysis of blood - leukocytosis and an increase in ESR, dysproteinemia , acidosis . Protein is found in the urine .

21. Emergency care for hyperthermic syndrome in children at the initial stage 1. According to the recommendations of the world health organization , the drugs of choice for emergency care for hyperthermic syndrome are paracetamol or ibuprofen . 2. If the skin is hyperemic (" red fever "), it is necessary to unfold , undress the child , wipe the skin with 40 ° alcohol solution or wrap the child in a damp diaper , it is possible to use a blower ; using a cleansing enema with cool water ( approximately room temperature , ie 18–20 ° C). 3. If the skin is pale (" pale fever " or white fever ), before using physical methods of cooling , it is necessary to prescribe nicotinamide at a dosage of 0.005-0.01 g, with a frequency of admission up to 2-3 times within 24 hours .

22. Emergency care for hyperthermic syndrome in hospital 1. If antipyretics have already been used ( paracetamol , ibuprofen ), orally or rectally ( in suppositories ), intravenous administration of paracetamol ( infulgan ) is indicated . 2 . In order to improve vascular microcirculation and peripheral circulation , increase heat transfer , a solution of papaverine hydrochloride 2% ( Antispasmodic agent ) . is shown , no-shpa ( drotaverine ) . 3. Glucocorticoid hormones have a powerful antihyperthermic effect : hydrocortisone or prednisolone . They should be used for severe infectious diseases , suspected adrenal insufficiency and ineffectiveness of the antipyretic therapy .

23. Emergency care for hyperthermic syndrome in hospital 4. Continue using physical methods of cooling 5. If there is no effect , apply a lytic mixture . Children may be advised to introduce such a lytic solution in ampoules : 6. With severe anxiety , agitation , convulsions - seduxen 7. With a decrease in body temperature to subfebrile numbers ( ideally , up to 37.5 ° C), it is necessary to stop measures to reduce body temperature , continue treatment of the underlying disease .

24. Intoxication syndrome Intoxication syndrome is a symptom complex characterized by general weakness , adynamia , rapid fatigue , fever , sweating , and weight loss . Most lung diseases are accompanied by the development of a syndrome of general intoxication of the body or intoxication syndrome .

25. Intoxication syndrome This syndrome is caused by the body's response to inflammatory lesions of the lungs and bronchi , which affect both the function of the main regulatory systems of the body - the nervous , endocrine , cardiovascular , immune systems , and the state of the main systems and organs of the body, primarily the liver . The most difficult course and cause significant intoxication of the body are inflammatory lesions of the bronchi and lungs .

26. Treatment Provide child with peace of mind . Bed rest . Drinking plenty of fluids is a must . It is not necessary to force child to drink large quantities at a time . It is advisable to drink often and in small portions - one or two tablespoons every few minutes is enough . As a liquid , you can use lightly sweetened water or weak tea .