basics? Flashcards
risk factors for rti
naive immune system
small airway
increased contact w other kids
malnutrition
lack of breastfeeding
tobacco smoke exposure/ cooking fuel
overcrowding
comorbids
xray findings in pneumonia
air bronchogram
consolidation
patchy air space opacities
reticular nodular opacities
interstitial infiltrates
symptoms in urti vs lrti
URTI
no respiratory distress unless obligate mouth breathers (<6m) or croup/epiglotitits
feeding difficulties
disturbed sleep
runny nose
fever
sore throat
ear pain
LRTI
fever
cough
runny nose
tachypnea
recessions w creps
rhonchi
reduced breath sounds
rattles
types of URTI
Sinusitis
Tonsilitis
Pharyngitis
Croup
Epiglotitis
Retropharyngeal abscess
investigations for RTI
URTI- no need ix
LRTI-
FBC to see if viral/bacteria
CRP & procalcitonin- raised in bacterial inf but not recommended
nasopharyngeal aspirate (NPA) or nasal swab
cxr
croup
PEDIATRIC EMERGENCY
inflammation of larynx, trachea and bronchus
6m-3y/o (usually in 2nd year of life)
organism: parainfluenza, RSV, mycoplasma pneumoniae
sx: low grade fever, coryzal symptoms, barking cough, hoarse voice, loud stridor (d3-d5)
worse at night
aggarvated by coughing or crying
can lie down
+/- respi distress
+/- wheeze
CLINICAL DX
lateral nexk xray (not req)- steeple sign
visualize pharynx
pulse oximetry & abg to assess severity
PCR to id the pathogen
tx: sleep in upright position, humidified o2(severe), neb budesonide 2mg or oral dexa 0.15mg/kg (0.3-0.6 if mod/severe), neb adrenaline 0.5ml/kg (severe), +/- IV fluids, +/-intubation
cx: drowsiness (severe), cyanosis, lethargy, may req intubation, recession (mod to severe), secondar infection
ddx: fish bone(FBA), tracheitis, epiglotitis, retropharyngeal abscess
acute epiglotitis
organism: Hib. reduced incidence bc of vaccination
sx: high grade fever, lethargy, drooling, tripod position, toxicity, soft stridor, respi distress, does not want to lie down
ix: fbc, blood culture, lateral neck xray(thumb sign), direct laryngoscopy (edematous, cherry red epiglottis)
mx: intubation in OT, amox-clavulanic acid, 3rd gen cephalosporin
laryngoscope should be done after intubation
retropharyngeal abscess
bacterial: strep pyogens, staph aureus, h.influenzae
sx: high fever, sore throat, pain on swallowing, signs of a mass, stertor(snoring)
ix: lateral neck x ray(pre vertebral tissue), CT needed
mx: secure airway, abx and drainage
tracheitis
baccterial: s.aureus, Hib, strep pneumonaie
sx: high fever, toxicity, lethargy, soft stridor, cough, respi distress
ddx: croup
ix: bronchoscopy
mx: intubate, abx, toileting
types of LRTI
bronchiolitis
pneumonia
empyema
lung abscess
bronchiolitis
viral: rsv, parainfluenza
airway wall edema, excessive mucus secretion & epithelial cell denudation
<1yr old
RF: tobacco exposure, not breastfed, nursery, males
sx: expiratory wheeze, fever, cough, runny nose (d5!!), poor feeding, SOB, chest wall recession, respi distress
ask if got “noisy breathing” /“bunyi kahak”
may hear fine creps, hyperinflated chest
ix: NPA-> immunofluorescent or RT-PCR, cxr (hyperinflation, perihilar infiltrates (consolidation) & peri bronchiole cuffing)
ddx: viral pneumonia
mx: iv fluids, ng tube, o2 (spo2>93!!), hypertonic saline (neb), inhaled b2 agonist
hyperinflation: posterior 9 ribs!!
cx: repsi failure (abg), bronchiolitis obliterans (high res CT to dx)
BO: cough, wheeze, rhonchi, reduced breath sounds, creps even after acute illness. ct to dx (mosaic pattern, fibrosis, consolidation, hyperinflation w vasc attenuation)
pneumonia
viral
bacterial
atypical: chlamydia, bordetella pertussis, mycoplasma
atypical pneumonia
sx: +/- fever, symptoms for 2-4 weeks, mycoplasma: hemolytic anemia, jaundice, hepatitis, seizure. chlamydia: eye discharge
ix: PCR positive. cxr reticular opacities
mx: erythromycin 10-14days
mycoplasma
in kids above 5
sx: fever, chills, hacing cough 4/52, extra pulm sx (SJS, maculopapular rash)
ix: NS for PCR, fbc, LFT, IgM mycoplasma, cxr
mx: as above
whooping cough
pertussis (gram neg coccobacillus)
vaccine!! so seen before 3m old
sx has 3 stages
1. catarrhal (1-2/52): runny nose, malaise
2. paroxysmal stage (3/12): coughing // whooping cough, apnea. face will turn red pale then blue from coughing
3. convalesce (1-2/52): resolution of sx
ix: fbc (wbc-lymphocytes>50%), nasal swab->rt-pcr, cxr+/- consolidation
mx: as above
cx of pneumonia
parapneumonic effusion
empyema
lung abscess
pneumatocele
pneumothorax
atypical hemolytic uremic syndrome
wheeze
An inspiratory stridor suggests airway obstruction above the glottis while an expiratory stridor is indicative of obstruction in the lower trachea. A biphasic stridor suggests a glottis or subglottic cause. The causes of stridor can be classified according to the site of the obstruction.
