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402- Paediatrics > Acute respiratory illness > Flashcards

Acute respiratory illness Flashcards

1
Q

Signs of respiratory distress (7)

A

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

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2
Q

Signs of airway obstruction

A

Snoring

- Partial obstruction of the upper larynx

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3
Q

Normal and tachypnoea RR in neonate

A

Normal= 30-50

Tachypnoea >60

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4
Q

Normal and tachypnoea RR in infant and young children

A

Normal= 20-30

Tachypnoea

  • > 50 for infant
  • > 40 for young children
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5
Q

Normal and tachypnoea RR in older children

A

Normal= 15-20

Tachynponea >30

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6
Q

Community acquired pneumonia

  • Symptoms
  • Signs
A

Symptoms

  • Pyrexia
  • Cough
  • Dyspnoea

Signs

  • Decreased breath sounds
  • Bronchial breathing
  • Dullness on percussion
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7
Q

Community acquired pneumonia in children

- Aetiology

A

Viral in infants

Bacterial

  • S. pneumoniae
  • S.aureus
  • S. pyogenes
  • M. pneumoniae (older children)
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8
Q

Signs of severe CAP in infants

  • Temperature
  • Respiratory rate
  • Respiratory distress
  • Feeding
  • Cardiovascular signs
A

Temperature
- 38

RR
- >70

Respiratory distress

  • Intermittent apnoea
  • Grunting

Not feeding

Cardiovascular

  • Tachycardia
  • Cap refil >2 seconds
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9
Q

Signs of severe CAP in older children

  • Temperature
  • Respiratory rate
  • Respiratory distress
  • Cardiovascular signs
A

Temperature
- >38.5

Severe diffiulty in breathing

Cyanosis/ SaO2 <92%

Cardiovascular

  • Dehydration
  • Tachycardia
  • Cap refil > 2 seconds
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10
Q

Management of CAP

  • Home
  • Hospital
A

Home

  • Antibiotics
  • Safety net

Hospital

  • ABC
  • O2 is hypoxic
  • Antibiotics
  • Fluids
  • humidified high flow nasal cannulae/ CPAP
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11
Q

Complications of CAP

A

Effusion/ empyema

Abscess

Sepsis

Haemolytic uraemic syndrome

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12
Q

Haemolytic uraemic syndrome

A

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

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13
Q

Croup

  • Definition
  • Epidemiology
  • Aetiology
A

Laryngotracheobronchitis
- Viral inflammation of the airways

Mainly affects children 6months- 6 years

Aetiology

  • Parainfluenza virus - main
  • RSV
  • Influenza
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14
Q

High risk groups for bronchiolitis (7)

A
  1. Chronic lung disease
  2. Congenital cardiac disease
  3. Social deprivation
  4. Immunodeficiency
  5. Neuromuscular disease
  6. Infants <3 months
  7. Prematurity
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15
Q

Bronchiolitis

  • Definition and aetiology
  • Key features
A

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
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16
Q

Feature of severe Bronchiolitis

  • Oxygen
  • Respiratory effort
  • HR
  • Feeding
A

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
17
Q

Feature of moderate Bronchiolitis

  • Oxygen
  • Respiratory effort
  • HR
  • Feeding
A

Oxygen sats 92-95%

Respiratory effort

  • RR >50
  • Minor accessory muscle use
  • No apnoeas

Increased HR

Feeding

  • > 50-75% of normal
  • No dehydration
18
Q

Management of severe bronchiolitis

A

Admission

Humidified O2–> O2 above 92 %

  • Head box
  • Optiflow

CPAP if oxygen requirements are high (>40%)

Nasal suction

IV fluids

19
Q

Management of moderate bronchiolitis

A

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
20
Q

Moderate/ severe Acute asthma

- Management

A
  1. BURST therapy
    - 10 puffs of 100 mcg Salbutamol via spacer every 20 mins
    - 1 hour
    - Maintain O2 >92%
  2. In severe: Add 4 (<5 yrs) or 8 (>5 years) puffs of ipratropium, every 20 mins
    - 1 hour
  3. 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.
21
Q

Management of life-threatening asthma

A
  1. RESUS and senior medical review
  2. Oxygen
    - maintain >92%
  3. Bronchodilation
    - Nebulised Salbutamol and ipratropium very 20 mins
  4. Steroids
    - Dexamethsone PO or IV hydrocortisone
  5. IV MgSO4 or salbutamol

If not responding

  • Transfer to ITU
  • Mechanical ventilation
22
Q

Croup management

A

Self care

  • Hydration
  • Paracetamol/ ibuprofen if distressed
  1. Oral/IM dexamethasone/
    - 0.15-0.3mg/kg Oral
    - 0.6mg/kg IM
    - Prednisolone as alternative

More severe cases:

  1. Oxygen
  2. Nebulised budesonide/ adrenaline
  3. Intubation + ventilation
23
Q

Indications for referral in bronchiolitis

A
  • RR > 60
  • Oral intake <75%
  • Clinical dehydration
  • O2 < 92
  • High risk children
24
Q

Score for quantifying croup severity

A

Westley score:

  • Stridor
  • Resp distress= retractions
  • GCS
  • Cyanosis
  • Air entry

Max score= 7

25
Q

Course of croup

A

Typically resolves within 48 hours

26
Q

Most common causative agent of epiglottitis

A

Haemophilus influenza type b

27
Q

Other less common causes of epiglottitis

A

S. pneunoniae

S.aureus

Haemolytic strep

28
Q

Presentation of epiglottis

A
  • High fever, sore throat (odynophagia)
  • Stridor
  • Drooling,
  • Respiratory distress
  • Hyperextended neck, tripod position
  • Cervical lymphadenopathy
29
Q

X-ray finding in epiglottis

A

Lateral Neck X-ray

- Thumbprint sign

30
Q

Epiglottitis management

A

Secure the airway
- Surgical tracheostomy may be required

IV antibiotics
- ceftriaxone/ cefotaxime

IV steroids

31
Q

Complication of epiglottitis

A

Epiglottic abscess

32
Q

Management of pertussis

A

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

33
Q

Prognosis of pertussis

A

Known as “100 day cough”

- Can last for several months, typically resolves in 8 weeks.

402- Paediatrics (15 decks)

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