Clin Med: LRTI Flashcards
Epiglottitis is classically associated with
H. influenzae type b (Hib)
Epiglottitis bacteria colonize where
nasopharynx and spread locally causing supraglottic cellulitis (inflammation of epiglottis and surrounding structures including larynx)
Epiglottitis: Inflamed structures mechanically obstruct ______
airway
increasing work of breathing and leads to resp failure
Epiglottitis most commonly seen in
children but not as much since vaccine of Hib
now m/c in males in their 40s
Epiglottitis presentation in children (4D’s)
drooling
dysphagia
dysphonia
distressed resp efforts
high fever
Epiglottitis: relinquishing of tripod position may herald
resp. failure
Epiglottitis adult presentation
ST
fever
dysphagia
drooling
no visible oropharyngeal inflammation
severe ST pain with a normal appearing pharynx should raise suspicion of epiglottitis
Epiglottitis will sometimes present with what lung sound
stridor
dx of Epiglottitis requires
laryngoscopy revealing beefy-red, stiff, edematous epiglottis
Epiglottitis: on lateral neck XR you will see
thumb sign
Abx of choice for Epiglottitis
ceftriaxone - use empirically, pending culture
Epiglottitis: Upon extubation, d/c home with PO abx usually –>
augmentin
Epiglottitis: Supportive measures
cool mist humidification with O2
IV fluids - no PO fluids
corticosteroids??
reduce anxiety
Laryngotracheobronchitis is aka
coup
Coup is
the inflammation of the larynx, trachea and bronchi
Coup presentation
classic barky or seal like cough, hoarse voice, high-pitched inspiratory stridor
Coup is m/c caused by what virus
parainfluenza virus (other: RSV, rhinovirus, enterovirus, influ, adenovirus)
Red flags with coup
drooling
dysphagia
toxic appearance
stridor without cough or without fever
incomplete immunizations
XR sign for coup
steeple sign - subglottic narrowing
Treatment for Coup
mild - one dose steroids then d/c home with return precautions
moderate - steroids, neb epi with obs. min 3 hours, reassess
severe - steroids, neb epi with obs. min 3 hours, reassess, admission?
Hib vaccine is important for what infection
epiglottitis
each epi dose observation is at min
3 hours
Bacterial tracheitis is aka
bacterial croup
Bacterial tracheitis is most common in what months
winter and fall months
Bacterial infection of trachea usually precedes
viral URI
bacterial tracheitis: Most common bacteria
staph aureus (including MRSA)
Coup is a very common cause of
cough, stridor and hoarseness
Epiglottitis vs coup
coup has a cough and no inflammation of the epiglottis
Coup is most commonly in (months)
october to early spring
Presentation of bacterial tracheitis
severe inspiratory and expiratory stridor
productive cough
fever
hoarse voice but no dysphagia
no tripoding or drooling
Dx/ workup for bacterial tracheitis
clinical dx
XR lateral neck if stable - will see “candle dripping” hazy around trachea
direct laryngoscopy - definitive dx
bronchoscopy - cultures of secretions based on severity
Bacterial tracheitis treatment
admit to ICU
aggressive airway management - ET intubation in ~75% of pts
antibiotics initiated ASAP - ceftriaxone plus nafcillin
humidified O2
Prevention of bacterial tracheitis by
vaccines: measles and influ, pneumococcus esp in immunocompromised children
Bronchiolitis most common cause
RSV
most causes of Bronchiolitis (mild) treatment is
supportive care only indicated
self limiting
Common complication of Bronchiolitis
recurrent wheezing - treat with ICS and leukotriene antagonists
Bronchiolitis pathophysiology
virus infects airway epithelial cells, induces inflammatory reaction leading to ciliary dysfunction and cell death
Bronchiolitis presentation
initial sx: URI - cough, fever, rhinorrhea
mild dx ~ only tachypnea
severe dx - retractions, grunting, cyanosis
Course of Bronchiolitis usually is
7-10 days
most infants improve within 14-21 days
Clinical dx of Bronchiolitis
RSV “wash”
XCR - hyperinflation, interstitial inflammation, atelectasis
Bronchiolitis treatment mild- moderate
mild = symptomatic care
mild-moderate = with nasal saline, antipyretics, cool mist humidifier, consider nasal cannula
Bronchiolitis treatment severe
admitted and monitored
humidified O2 and neb hypertonic saline
O2
prep for mech vent due to resp failure
Pertussis causative agent
bordetella pertussis and bordetella parapertussis
Pertussis pathophysiology
organism adheres to ciliated resp epithelial cells –> local inflammation –> release of toxins
Pertussis treatment abx
erythromycin - first line
azithromycin - alternative
Acute bronchitis is an infection of
the large airways due to viruses usually self limiting
Bronchitis usually follows any
viral upper resp infection (URI)
Acute bronchitis risk factors
current or past smoker
hx asthma
living in polluted place
crowding
Acute bronchitis is bacterial usually caused by
strep pneumoniae
Acute bronchitis pathophysiology
inflammation of bronchial wall leading to mucosal thickening - secondary to various triggers - usually viral
Acute bronchitis presentation
productive cough, malaise, difficulty breathing, wheezing
Prodrome of URI
high grade fevers unusual
What is the leading cause of hosp admission in infants under 1 year of age
Bronchiolitis
PE of acute bronchitis
lungs: +/- wheezing, +/- diffuse rhonchi
no other findings suggestive of PNE
Acute bronchitis treatment
usually self limited
symptomatic support - cough support
abx therapy not indicated
lifestyle modification - smoking cessation, allergen/irritant avoidance
Influenza is a viral disease that affects
upper and lower resp tract
Influenza gold standard for dx
PCR testing or viral cx of throat secretions
Influenza types that cause human infection
A and B
Influenza peaks during what months
winter (October to March)
Influenza complications in high-risk groups
PNE and death
most healthy pts recover fully from the flu within
7-10 days
Flu vaccine is recommended to
all individuals aged 6 months and older
influ virus replicates in
epithelial cell lining of upper and lower resp tracts
causes inflammation of the upper resp tree and trachea
Influ presentation
high fever, coryza, body aches
“like I got hit by a bus”
Flu treatment
self limiting
supportive care, fluids
antiviral meds - not needed in healthy individuals, mild infection
Flu mortality is higher in
children and seniors, esp with pre-existing lung diseases, DM
