Pediatric emergency medicine trisk 1395 1395
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functional abnormalities include bronchopulmonary dysplasia, respiratory distress
syndrome, bronchiectasis (e.g., in cystic fibrosis or ciliary dyskinesia), congenital
or acquired emphysema, and pulmonary fibrosis (e.g., from radiation and
chemotherapy).
TABLE 71.5
MOST COMMON ACUTE LIFE-THREATENING CAUSES OF
RESPIRATORY DISTRESS
Foreign body
Anaphylaxis
Epiglottitis
Tension pneumothorax
Pericardial tamponade
Several biologic and chemical agents that are potential weapons of terrorism or
warfare produce respiratory distress as their most predominant effect. These
include the biologic agents inhalational anthrax, pneumonic plague, pneumonic
tularemia, melioidosis; the toxins Staphylococcus enterotoxin B and ricin; and the
chemical agents chlorine and phosgene (see Chapter 132 Biological and Chemical
Terrorism ). Respiratory findings include cyanosis, chest pain, cough, hemoptysis,
dyspnea, tachypnea, stridor, rales, and/or wheeze. Chest radiographs may reveal
infiltrates, pulmonary edema, pleural effusions, widened mediastinum, abscesses,
and/or granulomas.
Nervous System
CNS disturbances may result in hypoventilation or hyperventilation, loss of
protective airway reflexes, or airway obstruction from loss of pharyngeal tone.
These conditions include CNS malformation, immaturity, infection, degenerative
disease, seizures, mass, trauma, and intoxication. Focal neurologic deficits, visual
disturbances, pupillary abnormalities, papilledema, abnormal muscle tone, and
altered level of consciousness suggest CNS processes. Spinal cord trauma and
anterior horn cell disease cause bulbar and respiratory muscle dysfunction, which
results in airway obstruction and/or hypoventilation. Peripheral neuromuscular
disorders (i.e., peripheral nerve, neuromuscular junction, muscle) result in muscle
weakness or paralysis. Physical findings that suggest chest wall weakness may
include hypotonia, hyporeflexia, muscle weakness, weak cry, hoarse voice,
cough, gag, shallow or irregular respiratory pattern, and inability to lift the head
or extremities (see Chapter 82 Weakness ).
Chest Wall/Thoracic Cavity
