Acute dyspnea (peds)

Background

• Breathing complaints common in pediatrics
• Infants/children have higher predisposition to respiratory failure relative to adults
  • Higher resting metabolic rate requires more oxygen
  • Anatomical differences (e.g. smaller diameter airways) predispose to respiratory failure
  • Vast majority of pediatric cardiac arrests are secondary to respiratory problem
• Included here are other respiratory chief complaints, such as tachypnea, irregular breathing, abnormal respiratory sounds or appearance, cyanosis, which parents may have noticed

Differential diagnosis

Pulmonary/airway

• Airway obstruction
• Anaphylaxis, angioedema
• Aspirated foreign body
• Asthma exacerbation
• Pneumonia
• Pneumothorax
• Respiratory distress syndrome
• Meconium aspiration syndrome
• Bronchiolitis (peds), URI
• Pertussis
• Bronchopulmonary dysplasia
• Croup
• Epiglottitis
• Bacterial tracheitis
• Tracheomalacia
• Cystic fibrosis exacerbation
• Pulmonary edema
• Pulmonary hypertension, cor pulmonale
• Inhalation exposure
• [[Rib fractures[[, Flail chest, pulmonary contusion
• Neoplasm

Cardiac

• Congenital heart disease
• Vascular ring
• Cardiac tamponade
• Cardiogenic pulmonary edema (CHF)
• Myocarditis

Other diseases with abnormal respiration

• Normal neonatal periodic breathing (misinterpreted by caregivers as abnormal)
• Brief resolved unexplained event
• Anemia
• Abdominal distension (e.g. SBO, liver failure
• Neonatal abstinence syndrome
• Decreased perfusion states
  • Pediatric shock
  • Sepsis (peds)
  • Dehydration (peds)
• Metabolic acidosis
  • Diabetic ketoacidosis (peds)
  • Inborn errors of metabolism
  • Salicylate toxicity
• CO Poisoning
• Diaphragm injury
• Renal Failure
• Electrolyte abnormalities
• Organophosphate toxicity
• Tick paralysis
• Fever (Peds)
• Panic attack
• Porphyria