Acute Respiratory- Peds Flashcards
Croup s/s
spasmoidic barky cough
croup tx
o Humidifier in room at night
o For a croupy cough, take the child into the bathroom with steam and stay in there for 5 minutes; take them immediately from the bathroom, to the freezer, open the freezer door and have them breath in the cold air. This helps with the croupy cough.
o Monitor for symptoms of difficulty breathing, as we discussed: nasal flaring, sucking in of the skin between the ribs and the clavicle. If concerned about respiratory distress, they should be seen immediately by their Pediatrician or in the Emergency Department.
o Push fluids
o VicksVapoRub on the chest
o Steroids
* Methylprednisolone only indicated when increased WOB/retractions present
acute upper respiratory infections (common cold): s/s
o Nasal congestion
o Headache
o Sore throat
o Cough
o Runny nose/nasal congestion
o Low grade fever (not always present)
acute upper respiratory infections (common cold): tx
- Zarbee’s cough syrup (if over 1 year of age; do not use in 12 months or younger d/t potential botulism– contains honey
- Loratadine/Cetirizine
- Flonase nasal spray: 1 squirt in each nostril twice daily
- Diphenhydramine before bed
- Humidifier in room at night
- Vicks VapoRub on chest/feet or behind the ears to help open eustachian tubes
- Can last for several weeks:
- Reassurance; should return to be seen again if:
- Increased WOB
- High fever not responsive to antipyretics or persisting
- Worsening cough that is affecting sleeping/mood/energy
- Increasingly fussy while tugging at ears
common cold/URI: s/s in children <6 years old
o Average of 6-8 colds/year (one per month)
o Typical symptom duration of 14 days
o Infants
* Fever and nasal discharge common manifestations—fever uncommon in older children and adults
* Additionally may be fussy, have difficulty feeding, decreased appetite and difficulty sleeping
common cold/URI: older children and adults
o Average of 2-4 colds per year
o Typical symptom duration of 5-7 days, duration increased among cigarette smokers
o Fever uncommon
prevention of common cold
o Handwashing, use of alcohol-based hand disinfectant, gloves, masks
o Zinc supplements
o Probiotics
o Gargling tap water or diluted povidone iodine solution
o Ginseng
o Exercise (45 mins)
tx of common cold
o Antihistamine
o Antihistamine combo
o Decongestant
o Intranasal ipratropium
o Antitussives
o Vapor rub
o NSAIDS
o Abx if it is bacterial
pneumonia
- Infection in the lung parenchyma (functional tissue)
*Common or “typical” bacterial etiology is S. Pneumoniae - Atypical bacteria (i.e. Mycoplasma) are more common in older children
pneumonia: physical exam
Full HEENT and respiratory exam
* Significant findings: rales that do not clear with cough, bronchial breath sounds, dullness to percussion, egophony
s/s of pneumonia
o Fever
o Cough
o Wheezing (if >5 yrs old and no hx of wheezing, may be atypical pna)
o Vomiting
o Chest pain
o Shoulder pain (UL) or Abdominal pain(LL)
o Difficulty feeding
o Restlessness
o Fussiness
clinical presenation of pneumonia
o Fever
o Tachypnea
o Respiratory Distress
* Tachypnea
* Working to breathe (infants: grunting, nasal flaring, retractions, use of accessory muscles)
* Hypoxemia
* Altered mental status
diagnosis of pneumonia
o Confirmed by Chest X-Ray (adults this is gold standard, however in peds, most outpatient cases do not require it)
* Anterior-posterior view and lateral
* Imaging:
CXR: can be normal in early disease, may show infiltrative changes
pneumonia: risk factors
o Neonates- prolonged rupture of membranes, maternal amnionitis, premature delivery, fetal tachycardia, maternal intrapartum fever
o Airway anomalies
o Severe underlying disease
o Prolonged hospitalization
o Hx of pneumonia
o Delayed care
o Household smoking
pedi tachypnea
- Younger than two months: >60 breaths/min
- Two to 12 months: >50 breaths/min
- One to 5 years: >40 breaths/min
- ≥5 years: >20 breaths/min
bacterial “typical” pneumonia: CAP
- May follow URI symptoms
- Abrupt in onset, with febrile patient appearing ill and sometimes toxic
- X-ray findings suggestive of bacterial pneumonia:
o Segmental consolidation
o Alveolar infiltrates
o Lobar consolidation
o “Round” PNA
“Atypical” Bacterial Pneumonia
- AKA “Walking” pneumonia
- Children of all ages, common in those >5y
- M. pneumonia (school, military, college) or C. pneumonia(neonates- Chlamydia trachomatis)
- Gradually worsening nonproductive cough despite improvement of other symptoms
- Diffuse rales and wheezing is a frequent finding in atypical bacterial
- Spreads diffusely along bronchial tree
x ray findings for atypical bacterial pneumonia
bilateral diffuse interstitial infiltrates
atypical
bilateral
typical
unilateral
pneumonia typical s/s
o Age: less than 5, over 40
o Onset: Abrupt
o Cough: Productive
o Sputum: Rusty/Purulent
o Rigors: Frequently present
o Fevers: > 39.5° c
o Consolidation: present
o Leukocytosis: 15- 25,000 with neutrophilia
pneumonia atypical s/s
o Age: < 40
o Onset: Gradual, coryzal prodrome
o Cough: Paroxysmal, non-productive
o Sputum: Minimal, mucoid
o Rigors: Absent
o Fever: Usually less than 39.5 °C
o Consolidation: Usually absent
o Leukocytosis: usually absent
tx
- Children-PIDS-IDSA Guidelines
CAP typical tx
- 1st line: amoxicillin
- Non-type 1 hypersensitivity to PCN: Cefdnir
- Type 1 hypersensitivity to PCN:
o Levofloxacin
o Clindamycin
o Erythromycin
o Azithromycin - Communities with high rate of pneumococcal resistance to PCN:
o Levofloxacin
o Linezolid - Infants <3-6 months with suspected bacterial pneumonia should be hospitalized
CAP atypical tx
azithromycin
viral pneumonia
- Usually children <5 years
- Onset of viral pneumonia is gradual and associated with preceding URI symptoms
- Child does not appear toxic
- Lung findings are usually diffuse and bilateral, wheezing is a frequent finding
- Consider rapid flu swab/COVID testing
x-ray findings for viral pneumonia
o Bilateral diffuse interstitial infiltrates
