Shallow breathing

Introduction Slow breathing is a symptom of severe respiratory failure. Difficulty breathing, three concave signs are obvious or not obvious, breathing changes from shallow to slow, rhythm disorder, often jaw breathing and apnea, respiratory sounds are reduced, lips cyanosis is aggravated, limbs are cyanotic, cold, lethargic or coma, Even horrified. In severe cases, cerebral edema (conjunctival edema or optic nerve head edema), cerebral palsy (different sizes on both sides of the pupil) may occur.

Cause

The causes of respiratory failure can be divided into three categories, namely, airway obstruction, lung parenchymal disease and abnormal breathing pump.

1. Respiratory obstruction Upper airway obstruction is more common in infants and young children. The larynx is the narrow part of the upper respiratory tract and is the main site of obstruction. It can be caused by infection, neurohumoral factors (throat), foreign body, and congenital factors (throat cartilage softening). Lower airway obstruction includes obstruction caused by asthma, bronchiolitis, and the like. Secretions in severe pulmonary infection, necrosis of viral pneumonia, can block the bronchioles, causing lower airway obstruction.

2. Pulmonary parenchymal disease.

(1) General pulmonary parenchymal disorders: including various pulmonary infections such as pneumonia, bronchiolitis, interstitial lung disease, pulmonary edema, etc.

(2) Neonatal respiratory distress syndrome (RDS): mainly due to immature lung development in premature infants, pulmonary surfactant deficiency caused by extensive atelectasis.

(3) Acute respiratory distress syndrome (ARDS): often occurs in severe infections, trauma, major surgery or other serious illnesses, characterized by severe lung injury. The infiltration and edema of the interstitial and alveolar diffuse of the two lungs is a pathological feature.

3. Breathing pump abnormal breathing pump abnormalities include lesions from the respiratory center, spinal cord to respiratory muscles and thoracic regions. A common feature is the lack of ventilation. Cerebral edema and intracranial hypertension caused by various causes can affect the respiratory center. The lesions of the nervous system can be soft paralysis, such as acute infectious polyradiculitis, or tonic spasms such as tetanus. Abnormal breathing pump can also cause sputum weakness, resulting in airway obstruction, atelectasis and infection, making the original respiratory failure worse. Respiratory failure caused by chest surgery is also common.

an examination

Related inspection

Carbon dioxide partial pressure (PCO2, PCO2) Total carbon dioxide (TCO2) Lung ventilation maximum exhalation mid-flow flow respiratory movement examination

Although blood gas analysis is the main means of diagnosing respiratory failure, the comprehensive diagnosis and evaluation of the child's condition can not rely solely on blood gas, but also make a comprehensive diagnosis and analysis based on medical history, clinical manifestations and other examination methods.

Medical history

At present, there are many instruments to check, and we should pay attention to the detailed history. The importance of diagnosis of respiratory failure is that it is often replaced by other diagnostic methods, which not only helps us understand the basis of the disease, but also facilitates Targeted treatment. The following are the things you need to pay attention to.

(1). Current diseases: what diseases are currently suffering, whether there is infection or major surgery, which are high risk factors for ARDS; whether there are lung, heart or nervous system diseases, these diseases may lead to respiratory failure; Metabolic disorders, uremia or diabetic acidosis can resemble respiratory failure, and attention should be paid to identification.

(2). Whether there is any accident: whether there is an accident that suddenly causes difficulty in breathing, such as vomiting or inhalation of foreign body, which is especially likely to occur in infants and young children; whether or not the drug that can inhibit breathing is accidentally taken.

(3). History of trauma: traumatic brain injury, chest trauma can affect breathing, with or without drowning or respiratory burns.

(4). What kind of treatment has been treated by the child: whether the drug that inhibits breathing has been used, whether the tracheal intubation or tracheotomy has been performed, and whether or not the pneumothorax is caused.

(5). Past history: history of dyspnea, history of asthma or respiratory allergy.

(6). History of neonatal: pay attention to the perinatal history, such as the mother's medication, whether the delivery is smooth, whether there is premature delivery, whether there is intrauterine asphyxia, or congenital malformation causing respiratory distress (such as diaphragmatic hernia, esophageal atresia) . A diagnosis should be made based on dynamic observations as the disease progresses. Children with respiratory acidosis should pay attention to the compensation situation. The blood pH of the uncompensated person decreases, which has a great impact on the child. Compensatory ability is affected by various aspects of kidney function, circulation and fluid balance. The compensation for acute respiratory failure takes 5 to 7 days. Therefore, if the child has been onset for several days, it is necessary to pay attention to the child's previous breathing and blood gas changes in order to make an accurate judgment of the current condition. For example, acute respiratory failure that has not been compensated for 2 days and respiratory failure with 8 days of onset may have the same blood gas change (PaCO2 is increased, BE is normal).

Differential diagnosis

Respiratory rate slows down and rules: breathing slows irregularly seen in overdose of hypnotics, sleeping pills are also known as stable, the main ingredient is Xipan, this product is white or off-white crystalline powder; odorless, slightly bitter taste. Almost insoluble in water, soluble in hydrochloric acid. In the case of acid or alkali and heat and easy to hydrolyze, the oral drug is opened under the action of gastric acid, enters the alkaline intestine and re-cyclizes the original drug. Therefore, the bioavailability of the drug is not affected. Anxiety, compensatory rebound is lighter after stopping the drug, and it is difficult to stop the drug. The aftereffect is lighter. The safety range is large.

Respiratory failure: Respiratory failure is a serious disorder of respiratory function, so that normal breathing can not be performed at rest, hypoxia or carbon dioxide retention, causing a series of clinical and metabolic disorders of clinical syndrome. In the early stage of illness, only breathing is strong. When it is severe, it is not easy to breathe, sweating is dripping, nails and nails are prominent, mental function changes, directional dysfunction, headache, insomnia, sorrow, irritability, turmoil, and then lethargy, causing coma, convulsions , heart rate is accelerated, blood pressure is elevated, skin vasodilatation and the like. Some severe patients have oliguria, lower extremity edema or liver damage and gastrointestinal bleeding.

Cardiogenic respiratory distress: refers to cardiogenic dyspnea caused by factors such as increased hydrostatic pressure, common in cardiac edema caused by left ventricular dysfunction, and thus caused by respiratory failure. Cardiac dyspnea is mainly caused by left heart and/or right heart failure. The mechanism of the two is different. The dyspnea caused by left heart failure is more serious.

Difficulties in inhalation: Inspiratory difficulty is an important symptom of respiratory insufficiency. It is subjectively characterized by insufficient air or difficulty in breathing; and objectively manifested as changes in respiratory rate, depth, and rhythm.

Cardiac dyspnea : Cardiac pulmonary edema caused by left ventricular dysfunction.

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