Acute Respiratory

Question 1

Viral Croup ages

Answer 1

<5Y

Question 2

Viral Croup is inflammation of the?

Answer 2

Mucosal Lining of the:

• Larynx
• Trachea
• Bonchi
• causing narrowing

Question 3

Croup Stage 1

Answer 3

• Fever
• Anxiety
• Hoarseness
• Brassy cough
• Inspiratory stridor when disturbed

Question 4

Croup Stage 2

Answer 4

Stage 2

• Continuous stridor
• Lower lip retraction
• Retraction of soft neck tissue
• Use of accessory muscles
• Labored breathing
• Maybe hospital?

Question 5

Croup Stage 3

Answer 5

Stage 3

• Signs of anoxia and CO2 retention
• Restlessness
• Anxiety
• Pallor
• Sweating
• Rapid respirations
• hospital

Question 6

Croup Stage 4

Answer 6

Cyanosis + Stop breathing

Question 7

What meds should be avoided with croup?

Answer 7

Cough syrups + cold meds

Question 8

Medicines for Croup

Answer 8

Racemic Epi (less mucus)
Corticoid steroids
-Broncodilators NOT helpful

Question 9

signs of worsening Croup

Answer 9

1. Inc RR
2. Increased agitation, restlessness, anxiety, and dec LOC
3. Cyanosis

Question 10

Epiglottitis is also called?

Answer 10

Bacterial Croup

Question 11

Bacteria that cause Epiglottitis (Bacterial Croup)

Answer 11

H. Influenza B or Streptococcus pneumoniae
-Can be immunized

Don’t sound bad but look worse!
-Serous life threatening!

Question 12

Age for bacterial Croup

Answer 12

2-5Y

Question 13

Epiglottitis: Presentation

Answer 13

•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

Question 14

Bronchiolitis: Def

Answer 14

Acute viral infection resulting in inflammation of the smaller bronchioles, characterized by thick mucus and can’t breath around it

Question 15

Most common cause of Bronchiolitis

Answer 15

RSV

Question 16

Common Age for Bronchiolitis

Answer 16

<2Y

Question 17

How is RSV spread?

Answer 17

Respiratory Secretion: Droplet Isolation

Skin: 0.5 hours
Surfaces: Hours

Fall + winter

Question 18

Bronchiolitis Symptoms

Answer 18

• 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

Question 19

Most common test for Bronchiolitis

Answer 19

SNOG (viral culture)

Question 20

Bronchiolitis: Treatment

Answer 20

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

Question 21

RSV vaccine

Answer 21

Palivizumab (Synagis): monoclonal antibody vaccine for at risk infants and children <2

Question 22

Types of Pneumonia

Answer 22

1. Viral
2. mycoplasma,
3. bacterial (S. pneumoniae most common),
4. aspiration
5. inhalation
6. via blood stream

Question 23

Pneumonia: S/S

Answer 23

Pneumonias
Inflammation of the alveoli: May be primary or secondary

Etiology:

1. Viral
2. mycoplasma,
3. bacterial (S. pneumoniae most common),
4. aspiration
5. inhalation
6. 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

Question 24

Complications of Pneumonia

Answer 24

1. Empyema
2. Pyopneumothorax
3. Tension pneumothorax
4. Pleural effusion

Question 25

Pneumonia: Treatment

Answer 25

- 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)

Question 26

Pertussis: Manifestations

Answer 26

Unimmunized children <4Y & >10Y Infants: <6M apnea >6M: paroxysmal cough Older kids: Persistent cough

Question 27

Pertussis: Treatment

Answer 27

1. Erythromycin 2. Infants <6M may need ventilator support 3. Humidified O2 4. Maintain Hydration 5. Watch for and prevent pneumonia

Question 28

When do kids have decreased resistance to TB?

Answer 28

- 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

Question 29

Apnea or ALTE looks like?

Answer 29

Some combination of: 1. Apnea >20s 2. Color change 3. Marked change in muscle tone 4. Choking or gagging

Question 30

Monitoring of ALTE

Answer 30

-Continuous cardiorespiratory monitoring until episode free for 6 months

Question 31

Etiology of ALTE

Answer 31

50% idiopathic 50% other disorders Increased risk of SIDS

Question 32

SIDS

Answer 32

Sudden infant death <1Y that occurs during sleep *leading cause of death in infants 1-12 months

Question 33

SIDS epidemiology

Answer 33

Highest in minorities Increased in: - Males - Winter - Poor Peak age 2-4 months, 95% within 6 months

Question 34

RF for SIDS

Answer 34

- 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

Question 35

Preventing SIDS

Answer 35

Place infant on back