Asthma, Bronchiolitis, RSV

Question 1

Symptoms of severe Asthma

Answer 1

Any of....
RR  ≥ 25
HR  ≥  110
Unable to speak in complete sentences
Peak flow

Question 2

Clinical signs of life threatening asthma attack

Answer 2

Altered loc
Exhaustion
Pulsus paradoxsus
Inadequate cardiac output
Cyanosis
Silent chest
Poor resp effort

Peak flow

Question 3

What is Pulsus paradoxsus

Answer 3

Difference in systolic Bp of 10mmHg between inspiration and expiration.

Hard to get, but radial will get stronger on inspiration

Question 4

Describe the differences in the pediatric patient related to airway obstruction

Answer 4

Children have proportionally larger tongues then adults (tongues are the most common form of airway obstruction
Pharynx is smaller
Poor mucous control
Epiglottis is high and large as well
Trachea is narrow and less rigid (more likely to collapse)

Stridor is inspiratory wheeze- only children (r/t URT collapse)

Question 5

What Bronchiolitis?

Answer 5

• Inflammation of fine bronchioles and small bronchi
• Infection mostly occurs during winter and spring
• Most common lower respiratory illness in children younger than 2yr
• Young children more affected because their noses and small airways can become blocked more easily than those of older kids or adults
• peaks in 6 months

Question 6

Common agents of bronchiolitis

Answer 6

•Most responsible:
   o RSV  (respiratory syncytial virus)
causes 70% UR  (bronchiolitis)
   o Adenovirus
   o Parainfluenza virus

NOTE
• Influenza and other infections can lead to bronchiolitis
• Potential connection to asthma later in life

Question 7

How common is RSV

Answer 7

• up to 1/3 of children within their first year
• 2/3 within first RSV season
• nearly all by 2-3 years

Question 8

Clinical signs of Bronchiolitis

Answer 8

poor feeding
coughing
presence of nasal flaring and/or grunting &/or retractions
wheezing

Question 9

Tx for Bronchiolitis

Answer 9

• Hydration
• Oxygen
• Inhaled epinephrine
• Nebulized salbutamol
• Inhaled hypertonic saline
• Ribivirin

Question 10

Three key causes of wheezing of Asthma

Answer 10

Bronchospasm
Inflm
Inc mucous production

… constriction

Question 11

What is pulses paradoxsus

Answer 11

Difference in systolic of 10mmHg difference betewee ninspiration and expiration

Question 12

What is severe asthma in relation to peak flow? What is life threatening?

Answer 12

less then 50% is severe

less then 33% is life threatening

Question 13

How do anticholinergics act in inhaler for patient with asthma

Answer 13

Suppress parasympathetic response of bronchoconstriction… cause bronchodilation

Question 14

Beta agonist inhaler will have what side effect? (among many i’m sure)

Answer 14

Increase HR

Question 15

Describe some differences in a child’s upper airway from that in an adult

Answer 15

Children have proportionally larger tongues then adults (tongues are the most common form of airway obstruction
Pharynx is smaller
Poor mucous control
Epiglottis is high and large and floppy
Trachea is narrow and less rigid (more likely to collapse)

All lead to more airway complications in children

Question 16

What is the common cause of stridor in children

Answer 16

Stridor is inspiratory wheeze- only children (r/t URT collapse)

Question 17

What is the allergic triad?

Answer 17

Can come together

atopic dermatitis (eczema)
   allergic rhinitis
   allergy-induced asthma