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Child with respiratory distress
| Clinical Discipline(s)/Organ System(s) Paediatrics, Respiratory System, Emergency Medicine | Progress Test Topic(s) Child health |
Description
A 2 year old Māori boy presents to the Emergency Department with a 2 day history of coughing. He has a low grade fever, rapid breathing and audible wheeze. He is with two female caregivers. This is his fifth attack of cough and wheeze.
Progress Test-Type Questions: Question 1 | Question 2Applied Science for Medicine
- Anatomy of the respiratory system
- Fetal development of the respiratory system and congenital anomalies
- Pathogenesis of asthma
- Pharmacology of asthma medicines including salbutamol, salmeterol, ipratropium, montelukast, and inhaled steroids (beclamethasone, budesonide, fluticasone)
- Pharmacology of adrenaline inhaled for acute respiratory distress (croup)
- Pharmacology of antibacterials used in respiratory infection (benzylpenicillin and associated betalactams cephazolin, cefuroxime), macrolides (erythromycin, azithromycin)
- Anatomy of the respiratory system
- Fetal development of the respiratory system and congenital anomalies
- Pathogenesis of asthma
- Pharmacology of asthma medicines including salbutamol, salmeterol, ipratropium, montelukast, and inhaled steroids (beclamethasone, budesonide, fluticasone)
- Pharmacology of adrenaline inhaled for acute respiratory distress (croup)
- Pharmacology of antibacterials used in respiratory infection (benzylpenicillin and associated betalactams cephazolin, cefuroxime), macrolides (erythromycin, azithromycin)
Clinical and Communication Skills
- Immediate assessment of the sick child (severity of the respiratory distress and signs of impending respiratory failure)
- Basic cardiopulmonary resuscitation (CPR) and the choking child
- History from parent/carer; recognise the differences in history taking when dealing with children; document immunisation status
- Detailed examination of respiratory system including assessment of acute and chronic disease and cardiovascular examination
- Important differentiation of signs of upper airway obstruction versus lower airway obstruction in a child
- Assessment of growth and normal development of child
- Differential diagnosis of respiratory distress in young child
- Radiologic features of pneumonia
- Management of acute asthma: asthma medications, using a spacer, long-term prevention, lifestyle changes, asthma management plan
- Management of acute respiratory illness due to infection
- Importance of information/education, need to consider health literacy needs of patient and family/whānau
- Recognise the signs and symptoms of vaccine preventable disease including measles, pertussis and pneumococcal disease
- Immediate assessment of the sick child (severity of the respiratory distress and signs of impending respiratory failure)
- Basic cardiopulmonary resuscitation (CPR) and the choking child
- History from parent/carer; recognise the differences in history taking when dealing with children; document immunisation status
- Detailed examination of respiratory system including assessment of acute and chronic disease and cardiovascular examination
- Important differentiation of signs of upper airway obstruction versus lower airway obstruction in a child
- Assessment of growth and normal development of child
- Differential diagnosis of respiratory distress in young child
- Radiologic features of pneumonia
- Management of acute asthma: asthma medications, using a spacer, long-term prevention, lifestyle changes, asthma management plan
- Management of acute respiratory illness due to infection
- Importance of information/education, need to consider health literacy needs of patient and family/whānau
- Recognise the signs and symptoms of vaccine preventable disease including measles, pertussis and pneumococcal disease
Personal and Professional Skills
- Non-judgemental attitude to history of events
- Evaluating social history - lifestyle, housing, number of prior Emergency Department presentations
- Non-judgemental attitude to history of events
- Evaluating social history - lifestyle, housing, number of prior Emergency Department presentations
Hauora Māori
- Appropriate engagement with whānau including facilitating access to cultural support
- Health disparities for young Māori children; high respiratory disease burden in children aged under 5 years
- Awareness of health care disparities; e.g. tendency for medical practitioners to underprescribe preventer inhalers for Māori children with asthma and conscious attempt to avoid delivering poorer quality care
- Differential health literacy
- Understanding the barriers to care that whānau face such as impact of caring for sick child for working parents
- Ethnic differences in risk factors for respiratory conditions including inequities in immunisation coverage by ethnicity, warm housing and smoking rates
- Appropriate engagement with whānau including facilitating access to cultural support
- Health disparities for young Māori children; high respiratory disease burden in children aged under 5 years
- Awareness of health care disparities; e.g. tendency for medical practitioners to underprescribe preventer inhalers for Māori children with asthma and conscious attempt to avoid delivering poorer quality care
- Differential health literacy
- Understanding the barriers to care that whānau face such as impact of caring for sick child for working parents
- Ethnic differences in risk factors for respiratory conditions including inequities in immunisation coverage by ethnicity, warm housing and smoking rates
Population Health
- Epidemiology of acute respiratory illness in children
- Epidemiology of asthma
- Normal age-appropriate immunisation schedule
- Health problems that disproportionately affect Māori; socio-economic deprivation and other factors (e.g. poorer access to and quality of health care)
- Importance of smoking cessation in the household
- Housing as a determinant of health; overcrowding, quality of the indoor environment
- Community management of asthma
- Epidemiology of acute respiratory illness in children
- Epidemiology of asthma
- Normal age-appropriate immunisation schedule
- Health problems that disproportionately affect Māori; socio-economic deprivation and other factors (e.g. poorer access to and quality of health care)
- Importance of smoking cessation in the household
- Housing as a determinant of health; overcrowding, quality of the indoor environment
- Community management of asthma
Conditions to be considered relating to this scenario
Common
upper respiratory tract infection (including croup), lower respiratory tract infection (including pneumonia and bronchiolitis), viral-induced wheeze, asthma
upper respiratory tract infection (including croup), lower respiratory tract infection (including pneumonia and bronchiolitis), viral-induced wheeze, asthma
Less common but 'important not to miss'
aspiration of foreign body, whooping cough
aspiration of foreign body, whooping cough
Uncommon
congenital lung abnormality, congenital cardiovascular abnormality, epiglottitis
congenital lung abnormality, congenital cardiovascular abnormality, epiglottitis
