Pediatric emergency medicine trisk 1397 1397
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hypotension, JVD, and distant heart sounds, referred to as Beck triad, are seen in
fewer than one-third of patients. Pericardial tamponade may be caused by trauma,
infection, inflammation, malignancy, or cardiac surgery. Acute tamponade may be
immediately life threatening and must be relieved expeditiously by
pericardiocentesis. In children, congenital heart defects are the most common
cause of CHF. Other cardiac causes of CHF include valvular heart disease,
myocardial dysfunction, arrhythmias, ischemia, and infarction. Metabolic
disturbances, sepsis, fluid overload, and severe anemia may also result in CHF.
Pulmonary manifestations of CHF include tachypnea, increased work of
breathing, dyspnea on exertion, orthopnea, perioral cyanosis, cough, wheeze, and
bibasilar rales. Other manifestations include pallor, poor feeding, failure to thrive,
fatigue, tiring with feeds, diaphoresis, edema, tachycardia, weak thready pulses,
JVD, displaced point of maximum impulse, cardiac murmur, gallop, rub,
cardiomegaly, and hepatosplenomegaly. Vascular causes of respiratory distress
include pulmonary embolism, pulmonary hypertension, and pulmonary
arteriovenous fistula (see Chapter 99 Pulmonary Emergencies ).
Gastrointestinal
Abdominal obstruction, perforation of hollow viscous, laceration of solid organs,
hematoma, contusion, appendicitis, infection, inflammation, ascites, or mass may
result in impaired diaphragmatic excursion secondary to abdominal distension
and/or pain. Prolonged shallow respiration may result in pulmonary
hypoventilation. Gastroesophageal reflux or vomiting, particularly in children
unable to protect their airway, may result in subglottic inflammation and/or
pulmonary aspiration (see Chapter 91 Gastrointestinal Emergencies ).
Metabolic and Endocrine Disturbances
Metabolic disturbances often manifest as compensatory alterations in respiratory
status. Metabolic acidosis results in rapid, deep breathing. Hyperammonemia
directly stimulates the respiratory center to produce tachypnea, which results in
primary respiratory alkalosis with secondary metabolic acidosis. Disruption of O2
metabolism is another cause for respiratory distress. Endocrine disturbances that
cause alterations in metabolic rate or chemical imbalances also result in
respiratory distress (see Chapter 89 Endocrine Emergencies ).
Hematologic
Inadequate concentrations of hemoglobin, or hemoglobin with decreased oxygencarrying capacity, result in deficient O2 delivery to tissues. Polycythemia results
