Pediatric emergency medicine trisk 348

flatter, fatigues; during rapid
eye movement sleep,
intercostal muscle
movements become
uncoordinated


TABLE 71.3
CAUSES OF RESPIRATORY DISTRESS


Respiratory system
Upper airway obstruction
Nasopharynx (craniofacial anomalies, choanal atresia, nasal congestion,
adenotonsillar hypertrophy, foreign body, trauma, mass)
Oropharynx (macroglossia, micrognathia, midface hypoplasia, tonsillitis,
peritonsillar abscess, Ludwig angina, trauma)
Larynx (epiglottitis, laryngomalacia, hemangioma, papilloma, webs, cysts,
laryngoceles, laryngotracheal cleft, subglottic stenosis, croup,
retropharyngeal abscess, tracheitis, anaphylaxis, angioneurotic edema,
trauma, thermal or chemical burn, foreign body, vocal cord paralysis,
laryngospasm, hypocalcemic tetany, mass)
Trachea (tracheomalacia, stenosis, tracheoesophageal fistula, foreign body,
mass)
Bronchi (bronchomalacia, stenosis, bronchogenic cyst, bronchitis, foreign
body)
Lower airway obstruction/acinar/interstitial disease
Bronchioles (asthma, bronchiolitis, allergy, angioneurotic edema,
bronchiectasis)
Acini/interstitium
Disorders of lung maturity (transient tachypnea of newborn, respiratory

distress syndrome, bronchopulmonary dysplasia, persistent fetal
circulation)
Congenital malformation (congenital emphysema, cystic adenomatoid
malformation, sequestration, pulmonary agenesis/aplasia/hypoplasia,
pulmonary cyst)
Aspiration (meconium, foreign body, near drowning, gastroesophageal
reflux, vomiting)
Infection (pneumonia; bacterial, atypical bacteria, viral, chlamydial,
pertussis, fungal, pneumocystis)
Pulmonary collapse (atelectasis), fluid (consolidation, edema, hemorrhage),
mass
Environmental/trauma (high-altitude pulmonary edema, thermal or chemical
burn, smoke, carbon monoxide, biologic and chemical agents,
hydrocarbon, drug-induced pulmonary fibrosis, bronchopulmonary
traumatic disruption, pulmonary contusion)
Central nervous system


Structural abnormality (agenesis, hydrocephalus, mass, arteriovascular
malformation)
Dysfunction/immaturity (apnea, hyperventilation/hypoventilation)
Infection (meningitis, encephalitis, abscess)
Inherited or acquired degenerative disease
Intoxication, central nervous system depression (alcohol, barbiturates,
benzodiazepines, opiates, neurotoxins)
Seizure
Trauma (birth asphyxia, hemorrhage)
Spinal cord (congenital anomaly, tetanus, trauma)
Anterior horn (poliomyelitis, transverse myelitis, spinal muscular atrophy)
Peripheral nervous system

Peripheral motor nerve (phrenic nerve injury, Guillain–Barré syndrome,
multiple sclerosis, tick paralysis, heavy metal or organophosphate toxicity,
porphyria)
Neuromuscular junction (myasthenia gravis, botulism, snake bite,
organophosphate toxicity, antibiotics)
Muscle (muscular/myotonic dystrophies, IEM, carnitine deficiency,
polymyositis/dermatomyositis, fatigue)
Chest wall/intrathoracic
Air leak (pneumothorax, tension pneumothorax, pneumomediastinum,
pneumopericardium)
Space-occupying (esophageal foreign body, pleural effusion, empyema,
chylothorax, hemothorax, anomalies of the great vessels, diaphragmatic
hernia, cyst, mass)
Bony and/or muscular deformity or dysfunction (congenital bone/muscle
absence, spine deformity, pectus excavatum/carinatum, diaphragmatic hernia,
contusion, rib fractures/flail chest, burn)
Cardiovascular
Congenital (structural defect, arrhythmia)
Acquired (cardiogenic shock, arrhythmia, valvular heart disease, myocarditis,
myocardial ischemia or infarction, pericarditis, pericardial effusion,
pericardial tamponade, aortic dissection or rupture, mass, coronary artery
dilation/aneurysm, congestive heart failure)
Gastrointestinal