Acute respiratory illness Flashcards
Signs of respiratory distress (7)
Recession
- Soft tissue being sucked in
- Intercostal
- Suprasternal
Use of accessory muscles
- Sternocleidomastoid
Head bobbing in infants
Nasal flaring
Expiratory grunting
Tachypnoea
Difficulty speaking/ eating
Signs of airway obstruction
Snoring
- Partial obstruction of the upper larynx
Normal and tachypnoea RR in neonate
Normal= 30-50
Tachypnoea >60
Normal and tachypnoea RR in infant and young children
Normal= 20-30
Tachypnoea
- > 50 for infant
- > 40 for young children
Normal and tachypnoea RR in older children
Normal= 15-20
Tachynponea >30
Community acquired pneumonia
- Symptoms
- Signs
Symptoms
- Pyrexia
- Cough
- Dyspnoea
Signs
- Decreased breath sounds
- Bronchial breathing
- Dullness on percussion
Community acquired pneumonia in children
- Aetiology
Viral in infants
Bacterial
- S. pneumoniae
- S.aureus
- S. pyogenes
- M. pneumoniae (older children)
Signs of severe CAP in infants
- Temperature
- Respiratory rate
- Respiratory distress
- Feeding
- Cardiovascular signs
Temperature
- 38
RR
- >70
Respiratory distress
- Intermittent apnoea
- Grunting
Not feeding
Cardiovascular
- Tachycardia
- Cap refil >2 seconds
Signs of severe CAP in older children
- Temperature
- Respiratory rate
- Respiratory distress
- Cardiovascular signs
Temperature
- >38.5
Severe diffiulty in breathing
Cyanosis/ SaO2 <92%
Cardiovascular
- Dehydration
- Tachycardia
- Cap refil > 2 seconds
Management of CAP
- Home
- Hospital
Home
- Antibiotics
- Safety net
Hospital
- ABC
- O2 is hypoxic
- Antibiotics
- Fluids
- humidified high flow nasal cannulae/ CPAP
Complications of CAP
Effusion/ empyema
Abscess
Sepsis
Haemolytic uraemic syndrome
Haemolytic uraemic syndrome
Characterised by the triad
- Thrombocytopenia
- Acute kidney failure
- Microangiopathic haemolytic anaemia
Typically occurs from E.Coli (diarrhoea), producing the shigella toxin
For pneumonia, S.pneumoniae is the most associated cause
Croup
- Definition
- Epidemiology
- Aetiology
Laryngotracheobronchitis
- Viral inflammation of the airways
Mainly affects children 6months- 6 years
Aetiology
- Parainfluenza virus - main
- RSV
- Influenza
High risk groups for bronchiolitis (7)
- Chronic lung disease
- Congenital cardiac disease
- Social deprivation
- Immunodeficiency
- Neuromuscular disease
- Infants <3 months
- Prematurity
Bronchiolitis
- Definition and aetiology
- Key features
Definition
- Acute, inflammation of the bronchial tree, most commonly caused by an infection of the respiratory syncytium virus (RSV)
Features
- Initial coryzal symptoms 1-3 days, Fever <39
- Persistent cough
- Crackles/ wheeze on auscultation
- Tachypnoea/ chest recession
- Symptoms peak day 3-5
Feature of severe Bronchiolitis
- Oxygen
- Respiratory effort
- HR
- Feeding
Oxygen sats < 92%
Respiratory effort
- RR>70
- Nasal flaring/ grunting
- Moderate/ marked accessory muscle use
- Apnoea
- Sweaty and tired
Increased HR
Feeding
- <50-75% of normal
- Dehydration
Feature of moderate Bronchiolitis
- Oxygen
- Respiratory effort
- HR
- Feeding
Oxygen sats 92-95%
Respiratory effort
- RR >50
- Minor accessory muscle use
- No apnoeas
Increased HR
Feeding
- > 50-75% of normal
- No dehydration
Management of severe bronchiolitis
Admission
Humidified O2–> O2 above 92 %
- Head box
- Optiflow
CPAP if oxygen requirements are high (>40%)
Nasal suction
IV fluids
Management of moderate bronchiolitis
Observations and monitoring
- At least 1 feed
- O2 Sats monitored for 4 hours
- Pre-feed saline nasal drops
Discharge if
- Normal feed (>50%)
- Normal oxygen (>92)
- Minimal work of breathing
If not..
Admit for:
- NGT feed (feeding <50%)
- O2 support
Moderate/ severe Acute asthma
- Management
- BURST therapy
- 10 puffs of 100 mcg Salbutamol via spacer every 20 mins
- 1 hour
- Maintain O2 >92% - In severe: Add 4 (<5 yrs) or 8 (>5 years) puffs of ipratropium, every 20 mins
- 1 hour - Oral Dexamethasone
Reassess for 30 mins after BURST
- Escalate to severe treatment if no improvement in moderate
- Escalate to life-threatening if no improvement in severe
If improvement
- Moderate: Reassess hourly, salbutamol 10 puffs every 1-4 hours
- Severe: Repeat BURST, salbutamol 10 puffs hourly. Reassess at 4 hours.
Management of life-threatening asthma
- RESUS and senior medical review
- Oxygen
- maintain >92% - Bronchodilation
- Nebulised Salbutamol and ipratropium very 20 mins - Steroids
- Dexamethsone PO or IV hydrocortisone - IV MgSO4 or salbutamol
If not responding
- Transfer to ITU
- Mechanical ventilation
Croup management
Self care
- Hydration
- Paracetamol/ ibuprofen if distressed
- Oral/IM dexamethasone/
- 0.15-0.3mg/kg Oral
- 0.6mg/kg IM
- Prednisolone as alternative
More severe cases:
- Oxygen
- Nebulised budesonide/ adrenaline
- Intubation + ventilation
Indications for referral in bronchiolitis
- RR > 60
- Oral intake <75%
- Clinical dehydration
- O2 < 92
- High risk children
Score for quantifying croup severity
Westley score:
- Stridor
- Resp distress= retractions
- GCS
- Cyanosis
- Air entry
Max score= 7
Course of croup
Typically resolves within 48 hours
Most common causative agent of epiglottitis
Haemophilus influenza type b
Other less common causes of epiglottitis
S. pneunoniae
S.aureus
Haemolytic strep
Presentation of epiglottis
- High fever, sore throat (odynophagia)
- Stridor
- Drooling,
- Respiratory distress
- Hyperextended neck, tripod position
- Cervical lymphadenopathy
X-ray finding in epiglottis
Lateral Neck X-ray
- Thumbprint sign
Epiglottitis management
Secure the airway
- Surgical tracheostomy may be required
IV antibiotics
- ceftriaxone/ cefotaxime
IV steroids
Complication of epiglottitis
Epiglottic abscess
Management of pertussis
Public health notification
- Prophylactic antibiotics for vulnerable close contact
Admission in
- Cyanosis, apnoea, severe coughing fits
Macrolide antibiotics in first 21 days
- Co-trimoxazole alternative
Prognosis of pertussis
Known as “100 day cough”
- Can last for several months, typically resolves in 8 weeks.
