RESPIRATORY DISTRESS IN THE NEWBORN: Tachypnea

Respiratory Distress: Approach to Tachypnea Author: Dr. Jody Platt Reviewer: Dr. Theresa Wu Student Reviewer: Respiratory Distress Tachypnea Normal RR, irregular RR or Bradypnea Stridor on inspiration Increased work of breathing (indrawing, nasal flare, head bobbing, paradoxical breathing) Reduced SaO2 and reduced air entry are red flags for impending respiratory failure Lower Airway (intra-thoracic obstruction present) See “Respiratory distress: Approach to Normal RR, irregular RR or Bradypnea Upper Airway (extra-throracic obstruction present) Wheeze on expiration Increased work of breathing (indrawing, nasal flare, head bobbing, paradoxical breathing) Crackles, bronchial breath sounds, focal respiratory findings SaO2 reduced Respiratory physical exam Check Respiratory Rate (RR) • Bronchiolitis* • Asthma*/Status Asthmaticus* • Foreign body* • Pneumonia* • Atelectasis • Pleural effusion • Pneumothorax • Anaphylaxis* • Croup* • Epiglottitis* • Tracheitis* • Foreign body* V/Q Mismatch Diffusion Problem • Congestive Heart Failure* • Congenital Heart Disease* • Pulmonary AVM • Pulmonary Hypertension *Indicates Key Condition This is not an exhaustive list of medical conditions. R à L Shunt • Interstitial lung disease • Acute respiratory distress syndrome • Pulmonary Edema Tachypnea with no increased work of breathing No increased work of breathing Normal SaO2 • Sepsis* with lactic acidosis • Diabetic ketoacidosis* • Metabolic disease