Acute Respiratory Emergencies in Children Flashcards
What is CROUP
A syndrome of laryngeal obstruction most commonly caused by a VIRAL infection in the subglottic region of the larynx
What is the peak for croup, when is a child least likely to get croup
2 years old, beyond 6
T/F: Croup and RDS are more common in boys than girls
True
What is Croup season
November to March
What is the most common virus to cause croup, other
Parainfluenza 1, Parainfluenza 2 and 3
What are the bacterial pathogens that cause croup, what do these also cause
Staph aureus, H. influenza, S. pneumoniae, M. cattarhalis/ Pneumoniae
How is croup virus transmitted, incubation period, period of virus shedding
Occurs by direct contact or droplets, 2-6 days, up to two weeks
What is the most common symptom of croup
Barking cough with sore throat
T/F: Humidifying a cool mist at HOME can aid in dealing with croup
True
What are the three possible drug treatments for severe croup
Systemic corticosteriods, nebulized racemic epinephrine, Antibiotics
What is the mainstay of treating croup
Corticosteriods: decreases capillary endothealeal permeability, airway inflammation, and laryngeal edema
T/F: Croup can only treat severe cases
False: Corticosteriods is indicated for mild, moderate, and severe croup
What is the preferred corticosteroid and dosing for croup, alternative
Dexamethasone: 0.15-.6 mg/kg as a SINGLE DOSE IM or PO (max of 10mg), Prednisone: 1 mg/kg as a SINGLE DOSE PO (max of 60 mg)
T/F: There is no difference in giving dexamethasone oral or IM
True
How does oral dexemethasone compare to oral prednisone in treating cases of croup
No difference in mild/moderate cases, less ED visits with Dexamethasone
What is the dose that should be used in moderate to severe cases
.6 mg/kg as single dose IM or PO (max of 10mg)
When should inhaled corticosteriods be given for croup
Reserved for moderate to severe cases in children who cannot take by mouth or cannot tolearate dexamethasone
What is the approved inhaled cortiosteroid for croup at what dose
Budesonide: 2mg in 4 ml NS nebulization as a single dose
What is nebulized racemic epinephrine used in croup
Morderate to severe cases, requiring mechanical intubation
T/F: Nebulized racemic epinehrine can be an alternative solo therapy to treat croup
False: Nebulized racemic epinephrine should be used as ADJUNCTIVE therapy for short-term treatment
What patients are contraindicated in using nebulized racemic epinephrine
Contraindicated in those with ventricular outlfow tract obstruction
What is the nebulized racemic epinephrine solution used and at what dose
2.25% solution: 0.25ml (less than 6 months) or 0.5ml (greater than 6 months) (Dilute in 2 to 3 ml of NS administered via nebulizer over 15 min)
If antibiotics are used what are used
Cefuroxime OR combination with nafcillin and ceftriaxone
When is broncholitis is most often seen in children, peak
Less than two years old, infants less than 6 months old
What is the most common cause of broncholitis
Respiratory syntical Virus, influenza
What are the risk factors for severe bronchiolitis
Age less than 3 months, history of prematurity (less than 37 weeks gestation), hemodynamically significant cardiac disease, chronic lung disease of prematurity
What are the severe symptoms of bronchiolitis
Apnea, hypoxemia, severe respiratory distress
What respiratory rate for bronchiolitis should be in the hospital
Greater than 60/min
What is the supportive therapy
Hydration
What drugs are no longer approved for broncholitis
Bronchodilators (albuterol)- increased heartrate/no change in hospitalization or oxygen therapy, nebulaized racemic epinephrine- treats symptoms but can be used as rescue for SEVERE only, cortiocsteroids- prolong shedding making it worse, antibiotics- reserved for concomitant bacterial infection, nebulized hypertonic solution- may be considered for infants with mild to moderate to hospital
How can broncholitis be prevented
hand decontamination, away from tobacco smoke, exclusively breastfeed for six months, limit exposure to childcare centers
What can be given for passive immunity
Palivizumab: binds F protein of RSV (per month)
What is the dosing for palivizumab how many doses can be given
15 mg/kg IM monthly during RSV season (Up to 5 doses November to March)
