Acute Respiratory Flashcards
Viral Croup ages
<5Y
Viral Croup is inflammation of the?
Mucosal Lining of the:
- Larynx
- Trachea
- Bonchi
- causing narrowing
Croup Stage 1
- Fever
- Anxiety
- Hoarseness
- Brassy cough
- Inspiratory stridor when disturbed
Croup Stage 2
Stage 2
- Continuous stridor
- Lower lip retraction
- Retraction of soft neck tissue
- Use of accessory muscles
- Labored breathing
- Maybe hospital?
Croup Stage 3
Stage 3
- Signs of anoxia and CO2 retention
- Restlessness
- Anxiety
- Pallor
- Sweating
- Rapid respirations
- hospital
Croup Stage 4
Cyanosis + Stop breathing
What meds should be avoided with croup?
Cough syrups + cold meds
Medicines for Croup
Racemic Epi (less mucus)
Corticoid steroids
-Broncodilators NOT helpful
signs of worsening Croup
- Inc RR
- Increased agitation, restlessness, anxiety, and dec LOC
- Cyanosis
Epiglottitis is also called?
Bacterial Croup
Bacteria that cause Epiglottitis (Bacterial Croup)
H. Influenza B or Streptococcus pneumoniae
-Can be immunized
Don’t sound bad but look worse!
-Serous life threatening!
Age for bacterial Croup
2-5Y
Epiglottitis: Presentation
•Clinical presentation-
–Abrupt onset, starts with sore throat
–High fever, mouth open, tongue protruding, drooling, agitation.
–Looks very sick, insists on sitting upright (tripod position)
–Sore red inflamed throat, difficulty swallowing
–Muffled voice, inspiratory stridor, No spontaneous cough
- Sitting forward and drooling! Get crash cart for intubation
- Never put anything in mouth.
•Intervention-Maintain the airway
–NO tongue blades! Don’t look in the throat
–Avoid x-ray and transport
–Let parents be with child
–Prepare for sedation & intubation
Bronchiolitis: Def
Acute viral infection resulting in inflammation of the smaller bronchioles, characterized by thick mucus and can’t breath around it
Most common cause of Bronchiolitis
RSV
Common Age for Bronchiolitis
<2Y
How is RSV spread?
Respiratory Secretion: Droplet Isolation
Skin: 0.5 hours
Surfaces: Hours
Fall + winter
Bronchiolitis Symptoms
- Apnea may be first sign
- Rhinorrhea (runny nose)
- Pharyngitis (sore throat)
- Coughing/sneezing
- Wheezing, crackles, decreased breath sounds
- Possible ear and eye infection
- Difficulty feeding
- Irritability
May progress to:
- Tachypnea
- Air hunger
- Retractions
- Cyanosis
Most common test for Bronchiolitis
SNOG (viral culture)
Bronchiolitis: Treatment
LOTS OF SUCTION + o2
Symptomatic treatment
- Antivirals: ribavirin (not usually given, fetal death)
- Bronchodilators: Albuterol, Xopenex, Racemic epi
*Mist tent or vaporizer
fluids, rest, antipyretics, pulse ox
RSV vaccine
Palivizumab (Synagis): monoclonal antibody vaccine for at risk infants and children <2
Types of Pneumonia
- Viral
- mycoplasma,
- bacterial (S. pneumoniae most common),
- aspiration
- inhalation
- via blood stream
Pneumonia: S/S
Pneumonias
Inflammation of the alveoli: May be primary or secondary
Etiology:
- Viral
- mycoplasma,
- bacterial (S. pneumoniae most common),
- aspiration
- inhalation
- via blood stream
Pneumonias: Manifestations
-Fever: mild to high
- Chest pain (may be referred to abdomen)
- Dullness to percussion
- Cough-nonproductive early, slight to severe
- Ronchi or fine rales, decreased breath sounds
- Respiratory distress
Complications of Pneumonia
- Empyema
- Pyopneumothorax
- Tension pneumothorax
- Pleural effusion
Pneumonia: Treatment
- Humidity oxygen therapy, antibiotics, maybe bronchodilators
- May need chest tube for purulent discharge
- May require postural drainage or CPT
- Supportive & symptomatic-rest, hydration
- Elevate HOB and allow child to assume a position of comfort
- Close observation of increased signs of respiratory distress (Monitor O2)
Pertussis: Manifestations
Unimmunized children <4Y & >10Y
Infants: <6M apnea
>6M: paroxysmal cough
Older kids: Persistent cough
Pertussis: Treatment
- Erythromycin
- Infants <6M may need ventilator support
- Humidified O2
- Maintain Hydration
- Watch for and prevent pneumonia
When do kids have decreased resistance to TB?
- Decreased resistance in infancy
- Decreased resistance during puberty & adolescence
Increased risk if in stress state:
- Injury, illness, steroids
- Nutritional deficiency
- Concurrent infections (MMR, HIV)
**Adequate nutrition is as important as adherence to medications
Apnea or ALTE looks like?
Some combination of:
- Apnea >20s
- Color change
- Marked change in muscle tone
- Choking or gagging
Monitoring of ALTE
-Continuous cardiorespiratory monitoring until episode free for 6 months
Etiology of ALTE
50% idiopathic
50% other disorders
Increased risk of SIDS
SIDS
Sudden infant death <1Y that occurs during sleep
*leading cause of death in infants 1-12 months
SIDS epidemiology
Highest in minorities
Increased in:
- Males
- Winter
- Poor
Peak age 2-4 months, 95% within 6 months
RF for SIDS
- Race + gender
- Preemie or low birth weight
- Multiple births
- Low apgar score
- CNS disturbances + respiratory disorders
- Later birth other
- Overheating
- Unsafe sleeping arrangment
- Bottle-fed
- old mom
- Smoking
- Drug users
- Poor prenatal care
Preventing SIDS
Place infant on back
