5. Respiratory Paediatrics Flashcards
What divides the upper and the lower repsiratory tract?
The epiglottis
What commensal bacteria do we have in our lungs?
Pneumococcus
Haemophilia
Staphylococcus
Moraxelaa
What are the harmful side effects of antibiotics?
Diarrhoea Allergic reaction Oral thrush Nappy rash Multi resistance
What makes children feel better?
Time
Sugary fluid
Brufen
What are some poor prognostic signs used in safety netting children?
Increased breathing effort
Severe vomiting
Loss of shiny patch on tongue due to dehydration
What are the signs of otitis media?
Erythema Bulging drum No light reflex Fever Ear pain Discharge 3-7 days
What are the signs of an URTI?
Runny nose Sniffles Malaise Fever Lasts 14-21 days
How do you treat Ottits media?
Analgesia works
Antibiotics work some times to slightly reduce but don’t do enough to justify treating the illness due to side effects
The end point is the same antibiotics or not
What is tonsillitis/pharyngitis
Sore throat Pus on throat Swinging fever, Scarlett rash Lasts 3-7 days Either EBV (glandular fever) or group A strep
What are the symptoms of croup?
What organism causes croup?
Bark seal cough Para flu 1 Common Hoarse Children are still very well Lasts 2-4 days
How do you treat croup?
Oral dexamethasone
What is epiglottis?
Cause flu H. Influenzas type B (were vaccinated)
Rare
Stridor
Throat
Drooling as throat is so sore they can’t swallow
High BP, low pulse
How do you treat epiglottis?
Intubation and antibiotics
What do you do if you’re not sure if a child will get better or worse?
HR
BP
Systemic symptoms
Safety net
What bacteria cause respiratory diseases?
Pneumococcus, Haemophilus, Staphylococcus, Haemophilius
How do you manage an LRTI?
Diagnose
Assess the patient (oxygenation, hydration, nutrition (chronic))- FIRST!
Antibiotics don’t work straight away, grey area on how to treat
What is bronchitis?
What organsism cause it?
Very very common esp in 2 years old Loose rattly cough, lots of sputum (darth Vader cough) Chest free of wheezes, crackles Sample has haemophilus, pnumococcus Child well, parent worried Lasts 7-21 days
Describe the pathophysiology of bronchitis?
Bronchitis paralyses cilia,
Cilia reactivates and clears sputum
2-3 weeks later happens again
Bronchitis paralyses cilia
What are the red flags for not bronchitis but something more serious?
Age <6month, >4 years- most important No relapse- remission- most important Static weight Disrupt child’s life Associates SOB Acute admission Other symptoms e.g. neuro/gastro
How do you treat bacterial bronchitis
Diagnose
Reassure parents
Don’t treat
Who gets bronchiolitis?
Every child born after 1 August with an older symptom
What is bronchiolitis?
What are the symptoms
What causes it?
LRTI Affects 30-40% of all children Usually RSV, paraflu III, HMPV Nasal stuffiness, poor feeding, tachypnoea Crackles +/- wheeze Lasts 2-3 weeks Affects children in 1 year One off thing
What is the timespan of bronchiolitis?
Gets worse for 2-3 days, becomes miserable
Stabilises 2 days
Recovers- gradually gets better
How do you manage bronchiolitis?
Maximal observations
Minimal interventions
What are the characteristics of a LRTI?
48 hours, fever (>38.5), SOB, cough, grunting
Wheeze males bacterial cause unlikely
Reduced or bronchial breath sounds (loud breath sounds)
Infective agents
Virus and commensal bacteria bacterium
What indicates pneumonia?
If you want to terrify the parents
Signs are focal
Crepitations
High fever
What should you not do in LRTI?
White cell count
Chest x-ray
How do you manage LRTI with antibiotics?
No symptoms are mild
Oral amoxicillin first line
Oral macrolides second choice
Only for IV if vomiting
What is pertussis?
Whooping cough Common Vaccine reduces risk and severity, still going to get it Coughing fits leads to Vomiting and colour change
When DO you give antibiotics in respiratory peadiatrics?
What agents are given
Otitis media if under two years and bilateral otitis media- oral amoxicillin
Tonsillitis if you know it’s strep- penicillin
LRTI/pneumonia- 2 days, fever focal sign, oral amoxicillin
What did bob Marley have to say about asthma?
NO WHEEZE NO ASTHMA
What decided whether you treat for asthma?
Quality of life affected- treat (not parents QoL, patients QoL)
Quality of life not affected- watch and wait
What are the characteristics of asthma?
Not a diagnosis of exclusion
Wheeze
Variability
Responds to treatment
What causes asthma?
What specific genes are associated with asthma?
Genes a moderate contributor (load the gun)
ADAM33, ORMDL3
Intact with environment (pull the trigger)
Epigenitcs
allergy (probably doesn’t cause asthma, allergy and asthma development happen in parallel)
What are the different classes of asthma that makes up asthma syndrome?
Infant asthma Childhood onset Adult onset Excertional asthma Occupational asthma
What are the diagnostic tests for asthma
There are no tests you idiot Peak flow sucks Allergy tests irrelevant Spirometery lacks specificity Nitric oxide- unproven
What is the NICE guidelines for investigating asthma?
First need clinical suspicion in child between 5 and 16
Spirometery
BDR (bronchodilator reversibility)
Exhaled nitric oxide
Peak flow (not very good)
What is a great sign of a respiratory problem
Shortness of breath at rest (30% of lung function)
Breathing with tummy muscles
How does cough diagnose asthma?
Dry cough, just after sleep, comes with exercise
What are the asthma signs?
Wheeze
SOB at rest
Parental asthma
Responds to treatment
What are the negative aspects Of asthma treatment?
Cost
Hassle
0.5-1cm loss in height
Oral thrush
What are the benefits of asthma treatment?
Helps diagnosis
If symptoms respond
Improves QoL
Reduces risk of attack
What are the differentials of asthma in children under 5?
Congenital Cystic Fibrosis Primary ciliary dyskinesia Bronchitis Foreign body
What are the differentials of asthma over 5?
Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis
How do yiu measure asthma control?
SANE Short acting beta agonist/ week? >2 poorly controlled Absence of school nursery Nocturnal symptoms/ week Exceptional symptoms/ week
What are the goals of asthma treatment?
Minimal symptoms day and night
Minimal need for reliever treatment
No attacks
No limitation of physical activity
What do you do if someone’s asthma is well controlled?
Leave as is?
Reduce treatment and hope it goes away
What do you do if someone’s asthma isn’t well controlled?
Ask these key questions: Not talking treatment
Not taking treatment correctly
Not asthma
if so increase treatment
How do you start asthma treatment?
Step up, step down process.
Started on low dose ICS
What are the classes of asthma medications?
Short acting beta agonist Inhaled corticosteroids Long acting beta agonist Leukotriene receptor antagonists Theophyllines Oral steroids
What is different in paediatric vs adulthood hood asthma?
Max dose ICS 800mcgs No oral B2 tablet LTRA first line in under 5's No LAMA's Only biological
What do you do in a child on a brown inhaler who is still poorly controlled?
Long acting beta agonists- slightly better than
Increased inhaled corticosteroids and
Leukotriene beta agonists
Keep an open mind though!
