Breathless and Noisy Breathing Flashcards
What would you worry about if a child had stridor that was getting quieter?
That they were becoming exhausted and respiratory failure is imminent
What would you worry about if a child’s stridor was becoming muffled?
Is there a differential diagnosis? Could this be epiglottitis?
What examination must NOT be performed in a child with stridor and why?
ENT exam - this should never be carried out in patients with upper airway obstruction as this may make it a lot worse
What are the signs of respiratory distress in children?
- Tracheal tug
- Tri-pod position
- Nasal flaring
- Intercostal recession
- subcostal recession
What is laryngomalacia?
Congenital laryngeal problem where the larynx is floppy. This causes a stridor worsening on feeding.
What is the problem of a laryngeal haemangioma?
If it is a slowly growing capillary haemangioma, this can obstruct the upper airway
What signs in a child increases the chance of a laryngeal haemangioma?
If the child has other capillary haemangiomas (strawberry marks) on their body.
How common is viral croup?
Very common
What is the typical age of onset of viral croup?
6 months - 3 years
What are the common signs of viral croup?
- Fever
- Barking cough
- Hoarse voice
- Normal swallowing
How do we manage viral croup?
Conservative, unless it is severe with respiratory distress
Epiglottitis is very rare, what is the common age group it affects?
2 - 7 years
How quickly does epiglottitis onset?
Very suddenly
What is the cause of epiglottitis?
Haemophilus Influenzae bacteria
What are the common symptoms of epiglottitis?
- Fever
- Muffled cough
- Muffled voice
- Patient leaning forward, neck extended
- Drooling
How do we manage a patient with epiglottitis?
Emergency airway management
Bacterial tracheitis is rare, what age patients can it affect?
6 - 14 months
What is the onset of bacterial tracheitis?
Sudden onset
What is the cause of bacterial tracheitis?
Bacterial; multiple organisms
What are the symptoms of bacterial tracheitis?
- Fever
- Hoarse cough
- Hoarse voice
- Drooling
How do we manage patients with bacterial tracheitis?
Emergency airway management
What are the prodromal signs of viral croup?
12-48 hour history of;
- non-specific cough
- rhinorrhoea
- fever
What should all children who are admitted with mild, moderate or severe croup receive?
A stat, single dose of oral dexamethasone (0.15mg/kg)
How long does viral croup usually take to self-limit?
48 hours
What signs do we see in mild croup?
- Seal-like barking cough
- No stridor
- No intercostal recession at rest
What signs do we see in moderate croup?
- Seal-like barking cough
- Stridor
- Sternal recession
What signs do we see in severe croup?
- Seal-like barking cough
- Stridor
- Intercostal/sternal recession
- Agitation or lethargy
What can we give nebulised to children with moderate or severe croup?
Adrenaline 5ml 1:1000
What does the term ‘anaphylaxis’ describe?
- Hypotension
- Bronchoconstriction
- Airway compromise
When assessing a child for risk of future anaphylaxis, what questions must we ask?
- Does your child have asthma?
- If yes, what treatment do they take?
- Do they take a regular preventer inhaler?
- When they had their initial reaction, how much of the foodstuff or allergen had they been in contact with?
What is a major risk factor for anaphylaxis?
Poorly controlled asthma
What type of hypersensitivity is a food allergy?
Type I
How does sensitisation occur and what are the underlying physiological mechanisms involved?
Following exposure to an antigen the protein causes cross binding of two bound IgE molecules on the Mast Cell or Basophil surface.
This process results in degranulation of the Mast Cell.
After a Type I hypersensitivity reaction, which immune mediator is released immediately?
Histamine - it is released after mast cell degranulation
What are the actions of histamine;
a. Vasodilation
b. Localised irritation
c. Endothelial separation
d. Vasoconstriction
e. Bronchoconstriction
f. Bronchodilation
a, b, c, e
What is the criteria for prescription of an adrenaline pen?
- Hx of anaphylaxis
- Previous cardiovascular/respiratory involvement
- Evidence of airway obstruction
- Poorly controlled asthma, requiring regular ICS
- Reaction to a small amount of allergen
- Ease of allergen avoidance
When a newborn/infant changes their feeding habits, what questions would you like to ask mum/dad/guardians?
- How much milk would they normally taken and how much are they taking now?
- How quickly has their decline in milk intake occurred?
- Establish why mum/dad/guardian think they stop feeding ; this can give us a lot of insight
- Explore any sleepiness as this is a VERY worrying sign
- Ask mum/dad/guardian their thoughts on what is happening
How do we assess feeding in newborns/infants?
mls/kg/day
What is the minimum milk requirement to provide enough calories to grow in newborns up to 1 month old?
150mls/kg/day
What is the minimum milk requirement to provide enough calories to grow in newborns over 1 month old?
100mls/kg/day as long as they are gaining weight
What is important information to gather about an infants PMHx?
The antenatal history - this accounts for a large portion of their development!!
- Maternal health - any infections, bleeding, conditions?
- Delivery - PPROM? PROM? NVD? LSCS?
- Gestation
- BW
- Post delivery - NICU? Any abnormalities?
What is the Westley-Croup score?
A tool used in assessing the severity of a Childs croup. This should only be used in conjunction with clinical assessment.
What is the maximum score on a Westley-Croup score?
17
At what score do we class a child as having ‘life-threatening croup’?
> 6
When a child presents with wheeze, why is it important to determine if the child is asthmatic or not?
This will help guide management. Asthmatic children will be given steroids (commonly dexamethasone) to help with their asthmatic exacerbation and reduce inflammation. This should not be a management plan for non-asthmatic patients.
List causes for newborn/childhood tachycardia
- Upset/distressed
- Pyrexia
- Pain
- Fear
- Cardia arrhythmia e.g. SVT
- Increase work - similar to exercise
- Cardiac/circulatory failure
- Shock (due to injury)
- Shock, commonly hypovolaemic
- Endocrine e.g. hyperthyroid
Give 4 reasons why a baby can be increasingly sleepy.
- Hypoglycaemic due to poor feeding
- Exhausted due to IWOB
- Encephalopathic due to infection both viral and bacterial
- Encephalopathic due to high ammonia secondary to a metabolic condition
- Neurological secondary to head injury
- Kernicterus due to increased bilirubin
- Hypoxia
When is foreign body aspiration most common?
Between 6 months and 3 years
