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Year 4 > Child Health - Resp > Flashcards

Child Health - Resp Flashcards

1
Q

what is bronchiolitis?

A

inflammation in the bronchioles (small airways of the lungs)

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2
Q

what usually causes bronchiolitis?

A

RSV

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3
Q

who does bronchiolitis usually occur in?

A

children under 1 year
most common in kids under 6 months
can rarely occur in kids up to 2 years old (more likely in kids who were premature with chronic lung disease)

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4
Q

how does bronchiolitis occur?

A

virus affects small airways of lungs causing swelling and inflammation
airways of infants are very small compared with adults so the swelling and mucus is proportionately larger and has significant effect of the infants ability to circulate air to the alveoli and back out

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5
Q

how does bronchiolitis present?

A 
harsh breath sounds
wheeze and crackles
coryzal symptoms
signs of resp distress
dyspnoea
tachypnoea 
poor feeding
mild fever (under 39)
can have apnoeas
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6
Q

coryzal symptoms?

A

snotty nose
sneezing
mucus in throat
watery eyes

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7
Q

signs of resp distress?

A 
raised resp rate
use of accessory muscles
intercostal and subcostal recessions
nasal flaring
head bobbing on breathing
tracheal tugging
cyanosis
abnormal airway noises
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8
Q

what are the accessory muscles?

A

sternocleidomastoid
abdominal muscles
intercostals

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9
Q

types of abnormal airway noises?

A

wheeze (expiratory)
grunting
stridor (inspiration)

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10
Q

what is the typical course of RSV?

A

usually starts as a URTI with coryzal symptoms
from this point, half get better and other half develop chest symptoms over 1-2 days following onset of coryzal symptoms
symptoms generally worst on day 3-4 and last 7-10 days in total
most patients recover fully in 2-3 weeks

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11
Q

children who have bronchiolitis as infants are more likely to suffer from what as adults?

A

viral induced wheeze

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12
Q

do all infants with bronchiolitis need admission?

A

no

most managed at home with advise about when to seek help

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13
Q

when might infants with bronchiolitis need admission?

A 
age under 3 months or any pre-existing condition such as prematurity, downs or CF
reduced feeding
clinical dehydration
resp rate >70
oxygen sats <92
mod-severe resp distress
apnoeas
parents not able to manage at home or live very far from medical help
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14
Q

how is bronchiolitis managed?

A

usually only need supportive management

  • ensure good intake
  • saline nasal drops/nasal suctioning to help clear secretions
  • oxygen
  • ventilatory support if required
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15
Q

how can adequate intake be ensured in bronchiolitis?

A

can be orally
via NG tube or IV fluids depending on severity
important to avoid overfeeding so start with small frequent feeds and increase gradually

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16
Q

types of ventilatory support in bronchiolitis?

A

high flow oxygen
CPAP
intubation and ventilation

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17
Q

how does high flow oxygen work?

A

delivered via tight nasal cannula
delivers air and oxygen continuously with some added pressure helping to oxygenate the lungs and prevent airways from collapsing
adds “positive end-expiratory pressure” (PEEP) to maintain airway at end of expiration

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18
Q

how does CPAP work?

A

continuous positive airway pressure
involves using a sealed nasal cannula that performs in a similar way to a normal oxygen nasal cannula but can delivery much higher and more controlled pressures

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19
Q

how can ventilation be assessed?

A

capillary blood gases are useful in severe resp distress and in monitoring children who are having ventilatory support

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20
Q

what are the most useful signs of poor ventilation?

A

rising CO2

falling pH

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21
Q

what does a silent chest indicate in acute asthma?

A

bad sign
indicates airways are so tight that its not possible for child to move enough air through airways to create a wheeze
may be associated with a reduced respiratory effort due to fatigue

22
Q

signs of moderate asthma attack?

A

peak flow 50-75% of predicted

increasing symptoms but not features of acute severe asthma

23
Q

signs of acute severe asthma?

A

any one of

  • peak flow 33-50% of predicted
  • resp rate >25
  • heart rate >110
  • unable to complete sentences
24
Q

signs of life-threatening asthma?

A

any one of

  • peak flow <33% predicted
  • oxygen sats <92%
  • PaO2 <8
  • silent chest
  • cyanosis
  • poor resp effort
  • arrhythmia
  • exhaustion
  • altered consciousness
  • hypotension
25
Q

staples of management in acute asthma in kids?

A

oxygen if needed
bronchodilators
steroids (oral prednisolone or IV hydrocortisone)
antibiotics only if a bacterial cause is suspected

26
Q

step up pathway of bronchodilators?

A

inhaled/nebulised salbutamol
inhaled/nebulised ipratropium bromide (anti-muscarinic)
IV magnesium sulphate
IV aminophylline

27
Q

general advise for home management of mild asthma with bronchodilators?

A

regular salbutamol inhaler via spacer 4-6 puffs every 4 hrs

28
Q

step-wise approach of management of mod-severe asthma?

A
  1. salbutamol via spacer starting with 10 puffs every 2 hrs
  2. nebulisers with salbutamol/iptratropium
  3. oral prednisolone
  4. IV hydrocortisone
  5. IV magnesium sulphate
  6. IV salbutamol
  7. IV aminophylline
29
Q

what do you do if all steps in managing mod-severe asthma fail to control it?

A

call anaesthetist and intensive care as they may need intubation and ventilation

30
Q

once asthma has been controlled, what do you do?

A

gradually work way back down the ladder as they get better

31
Q

what should be monitored when on high doses of salbutamol?

A

consider monitoring potassium (causes potassium to be absorbed from blood into the cells)
be aware that high dose salbutamol can cause tachycardia and tremor

32
Q

when can child be discharged after acute asthma?

A

when child is well on 6 puffs salbutamol every 4 hrs

33
Q

advise for at home care of child after discahrge from hospital for acute asthma?

A

prescribe reducing regime of salbutamol
finish course of steroids (usually 3 days total)
safety net
provide written individualised asthma plan

34
Q

what presentation suggests asthma?

A

episodic symptoms
diurnal variability (worse at night and early morning)
dry cough with wheeze and short of breath
typical triggers
history of atopy
bilateral widespread polyphonic wheeze
symptoms improve with bronchodilators

35
Q

what presentation suggests something other than asthma?

A 
wheeze only related to coughs and colds
isolated or productive cough
normal investigations
no response to bronchodilators
unilateral wheeze suggesting a focal lesion, inhaled foreign body or infection
36
Q

typical asthma triggers?

A 
dust
animals
cold air
exercise
smoke
food allergens
37
Q

how is asthma diagnosed?

A

no gold standard diagnostic criteria
usually a clinical diagnosis
trial of treatment if asthma is likely and if it works this is diagnostic

38
Q

investigations in asthma?

A

spirometry
direct bronchial challenge test with histamine or methacholine
fractional exhaled nitric oxide
peak flow variability (keep a diary for 2-4 weeks)

39
Q

long term management of asthma?

A

SILILTO

  • SABA
  • inhaled corticosteroid
  • LABA
  • increase corticosteroid
  • Leukotrine receptor antagonist
  • theophylline
  • oral steroids
40
Q

medical long term treatment of asthma in under 5s?

A
  1. SABA
  2. add low dose steroid inhaler or a LTRA
  3. add other option from step 2
  4. refer to specialist
41
Q

potential side effects of steroids in children?

A

can reduce growth and cause a small reduction in final adult height of up to 1cm when used continuously for more than 12 months
(dose dependent)
can cause oral thrush if poor technique

42
Q

what is croup?

A

laryngotracheobronchitis

acute infective URTI causing oedema in the larynx

43
Q

main cause of croup?

A

parainfluenza virus = main cause

  • influenza
  • adenovirus
  • RSV
44
Q

who gets croup?

A

children aged 6 months to 2 years

45
Q

how does croup present?

A 
stridor
barking cough
increased work of breathing
hoarse voice
low grade fever
46
Q

how is croup managed at home?

A

most can be managed at home with supportive treatment
fluids and rest
sit child up during coughing attacks

47
Q

how is croup managed medically?

A

single dose dexamethasone (150mcg/kg)

- can be repeated if required after 12 hrs

48
Q

stepwise approach in managing severe croup (in hospital)?

A 
oral dexamethasone
oxygen
nebulised budesonide 
nebulised adrenaline
intubation and ventilation
49
Q

what is epiglottitis?

A

inflammation and swelling of the epiglottis caused by infection

50
Q

why is epiglottitis an emergency?

A

epiglottis can swell to point of completely obscuring the airway within hours of symptoms developing

51
Q

what usually causes epiglottitis?

A

h. influenzae type B

52
Q

what presentation suggests epiglottitis?

A

….

Year 4 (83 decks)

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