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common resp paeds Flashcards

1
Q

what is chronic lung disease of prematurity?

A

bronchopulmonary dysplasia occurring in premature babies

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2
Q

what gestation is chronic lung disease of preemie seen?

A

typically 28wks

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3
Q

what features are seen in CLDoP?

A
  • Low oxygen sats
  • Increased work of breathing
  • Poor feeding and weight gain
  • Crackles and wheezes on chest auscultation
  • Increased susceptibility to infection
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4
Q

how can you prevent lung disease in preemies?

A

give corticosteroids to mothers showing signs of premature labour <36wks to help with fetal lung development

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5
Q

what management may be used in hospital for CLDoP?

A
  • CPAP rather than intubation and ventilation when possible
  • Using caffeine to stimulate the resp effort
  • Not over-oxygenating with supplementary oxygen
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6
Q

how do you decide what oxygen babies need for discharge with CLDoP?

A

need a formal sleep study to access their oxygen sats during sleep supports diagnosis and guides management
- Babies may be discharged from neonatal unit of low dose of oxygen to continue at home
- Babies may need low flow O2 at home  may need weaned the oxygen for first yr life

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7
Q

what is given to preemies to protect against bronchiolitis - RSV strain?

A
  • Require protection against RSV to reduce severity of bronchiolitis  need monthly injections of monoclonal AB against the virus called palivizumab (very expensive – reserved for babies in certain criteria)
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8
Q

what age does croup usually affect?

A

acute infective resp disease affecting young children
- Typically affects children 6mths to 2yrs

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9
Q

what is croup?

A
  • URTI causing oedema to larygnx
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10
Q

what can cause croup?

A

parainfluenza, influenza, adenovirus, RSV
- Can be caused by diphtheria

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11
Q

what does parainfluenza causing croup respond well to?

A
  • Parainfluenza virus: it improves in <48hrs and responds well to treatment in steroids particularly dexamethasone
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12
Q

what can diphtheria cause in relation to URTI?

A

can cause epiglottis and high mortality, vaccination mean that this is very rare in developed countries

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13
Q

how does croup present?

A
  • Increased work of breathing
  • Barking cough – clusters of coughing episodes
  • Hoarse voice
  • Stridor
  • Low grade fever
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14
Q

how do you manage croup?

A

most needs simple supportive treatment (fluids and rest)
- During attacks it can help to sit the child up
- Measures to be taken to avoid spreading infection eg hand washing and staying off school
- Oral dexamethasone if very effective – 150mcg/kg can be repeated in 12hrs
- Pred can be used as alternative

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15
Q

how is severe croup managed?

A

Severe croup: oral dexamethasone + oxygen + nebulised budesonide + nebulised adrenaline + intubation/ ventilation

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16
Q

how does pneumonia in paeds present?

A

cough (wet/ productive), high fever, tachypnoea, tachycardia, increased work of breathing, lethargy, delirium

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17
Q

what signs indicate pneumonia?

A

derangement in basic observation  sepsis secondary to pneumonia
- High RR, high HR
- Hypoxia
- Hypotension
- Fever
- Confusion
- Bronchial breath sounds
- focal coarse crackle
dullness to percuss

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18
Q

what are bronchial sounds?

A

equally harsh/ loud on inspiration/ expiration  consolidation of lung tissue around airway

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19
Q

what are focal coarse crackles?

A

caused by air passing through sputum similar to using a straw to blow into a drink

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20
Q

what are common causes of pneumonia in paeds?

A

: strep. Pneumonia (most common), group.A

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21
Q

who is most at risk of group B pnuemonia?

A
  • Group B: occurs in pre-vaccinated infants, often contracted during birth as it often colonises in vagina
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22
Q

how would a staph.a pneumonia present on CXR?

A
  • Staph.a: CXR would show pneumatoceles (air filled cavities) and consolidation in multiple lobes
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23
Q

what is the most common viral cause of pneumonia in paeds?

A

RSV most common
- Parainfluenza vius, influenza

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24
Q

what investigations are required within pneumonia investigation?

A

: CXR is investigation of choice for diagnosing pneumonia
- It is not routinely required: can be helpful if complicated
- Sputum cultures/ throat swabs for bacterial cultures/ viral PCR
- Blood cultures
- Capillary blood gas analysis can be helpful
- Blood lactate

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25
Q

how is pneumonia managed?

A

treated to antibiotics according to local guidelines
- Amoxicillin: first line
- Macrolide – erythromycin. Clarithroymcyin/ azithromycin  atypicals
- IV antibiotics: sepsis or intestinal absorption issue
- Oxygen is used as required if <92%

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26
Q

what is bronchiolitis?

A

: inflammation and infection of bronchioles – small airways of lungs

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27
Q

what usually causes bronchiolitis?

A

RSV

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28
Q

who is usually affected by bronchiolitis?

A
  • Usually in those <1yr mainly under 6mths
    not really seen in those 2+
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29
Q

how does bronchiolitis present if it is caused by RSV?

A

starts as URTI with coryzal symptoms  half get better spontaneously
- Other half develop chest symptoms over first 1-2days
- Symptoms usually worse on day 3-4
- Symptoms last 7-10 days

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30
Q

why do not older kids/ adults get bronchiolitis?

A

can affect adults but swelling and mucus are proportional to airway size  not as big of effect
- Even a small amount of inflammation and mucus in airway has an effect
- Significant effect on infants ability to circulate air to alveoli and back out
- Harsh sounds: wheeze, crackles

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31
Q

what is wheezing and what causes it?

A
  • Wheezing: whistling sound caused by narrowed airways – typically heard during expiration
32
Q

what is grunting and what causes it?

A
  • Grunting: caused by exhaling with glottis partially closed to increase positive end-expiratory pressure
33
Q

what is stridor and what causes it?

A
  • Stridor: high pitched inspiratory noise caused by obstruction of upper airway eg croup
34
Q

how does bronchiolitis generally present?

A

coryzal symptoms, signs of resp distress, dyspnoea, tachypnoea, poor feeding, mild fever, apnoea’s

35
Q

what are signs of respiratory distress in paeds?

A

raised RR
use of accesory msucles
intercostal recessions
subcostal recessions
nasal flaring
head bobbing
tracheal tug
cyanosis
abnormal airway noises

36
Q

describe tracheal tug?

A

with each breath - there is a huge dip by jugular notch

37
Q

what supportive care is given to to infants with bronchiolitis?

A
  • Ensuring adequate intake
    saline nasal drops and nasal suctioning
    supplementary oxygen
    ventilatory support if needed
38
Q

how do you ensure adequate intake?

A

orally, NG, IV fluids  overfeeding can restrict breathing – need small and frewquent feeds

39
Q

what do saline nasal drops/ nasal suctioning?

A

help clear nasal secretions esp prior to feeding

40
Q

how should supplementary oxygen be given in bronchiolitis?

A
  • Supplementary oxygen – if below 92%  want humidified so not going to dry them out
41
Q

how should ventilatory support be given in bronchiolitis?

A
  • Ventilatory support if required  high flow humidified O2, CPAP, intubation + ventilation
42
Q

how can assess ventilation in paeds?

A

Assessing ventilation: cap blood gases  good in severe resp distress and monitoring children in ventilatory support
- Done in big toe

43
Q

what would indicate poor ventilation?

A
  • Poor ventilation: rising CO2, falling pH
44
Q

what is palivizumab?

A

monoclonal AB that targets RSV

45
Q

how is palivizumab administered?

A
  • Given to high risk  ex-preemie, CHD pts
  • Provides passive protection – circulates body until virus is encountered  helps activate virus
  • Very expensive hence only given to those at biggest risk
46
Q

what is viral induced wheeze?

A

wheezy illness caused by viral infection
- Usually RSV or rhinovirus

47
Q

what causes viral induced wheeze??

A
  • Small amount of inflammation and oedema swells walls of airways and restricts airflow
  • Inflammation also triggers smooth muscles of airways to constrict  further narrowing of airways
  • Has big effect on little people
48
Q

how can you tell if it asthma or viral induced wheeze?

A

Not asthma?: asthma does not present < 3yr
- Asthma can be worsened by virus  by has other triggers
- Atopic Hx/ eczema  asthma

49
Q

how would viral induced wheeze present?

A

Presentation: viral illness 2-3 days prior
- SoB
- Signs of resp distress
- Expiratory wheeze throughout chest

50
Q

what is epiglottitis?

A

inflammation and swelling of epiglottis typically with HiB
- Epiglottis swells to the point of complete obstruction of airway within hrs of symptoms starting

51
Q

is epiglottitis an emergency?

A

life threatening

52
Q

how is epiglottitis incidence?

A
  • It is rare: due to vaccination programme against haemophilus b
53
Q

how does epiglottitis present?

A
  • Sore throat and stridor
  • Drooling
  • Tripod position – sat forward with hands on each knee
  • High fever
  • Difficulty or painful swallowing
  • Muffled voice
  • Scared and quiet child
  • Septic and unwell appearance
54
Q

what investigations can be used for epiglottitis?

A

: if acutely unwell and ?epiglottis – do not perform investigations
- Lateral XR of neck  thumb sign or thumb print – soft tissue shadow that looks like thumb pressed into trachea – oedematous and swollen epiglottitis
- XR can help exclude foreign body

55
Q

how do you manage epiglottitis?

A

EMERGENCY
1. Do not distress pt – this can cause closure of airway
2. If you see suspected epiglottitis – leave child alone and call senior and anaesthetist
3. Need to maintain airway – do not need intubation initially  may need on stand by
4. May need tracheostomy and ICU
5. IV antibiotics – ceftriaxone
6. Steroids – dexamethasone

56
Q

what is the prognosis of epiglottis?

A

: most children recover within intubation
- Most that are intubated can be extubated within a few days
- Death can occur if not managed in timely manner
- Risk of epiglottitis abscess

57
Q

what is laryngomalacia?

A

condition in infants where part of larynx above vocal cord (supraglottic larynx) is structured in a way that can cause partial airway obstruction
- Leads to chronic stridor on inhalation
- Stridor

58
Q

how does laryngomalacia present?

A

: occurs in infants – peak at 6mths
- Inspiratory stridor
- Intermittent and worse on feeding, upset, lying on back, during URTI
- Infants with laryngomalacia does not have associated resp distress

59
Q

what is laryngomalacia management?

A

usually gets better as they grow due to larynx maturing and better to support itself
- No interventions and child left to grow
- Tracheostomy may be needed 0 tube through front of neck to trachea bypassing larynx  surgery to help improve symptoms

60
Q

what is whooping cough?

A

: URTI caused by Bordetella pertussis (gram negative bacteria)

61
Q

where does whooping cough gets in name from?

A
  • Whooping cough name – coughing fits are so severe child can not take any air in between coughs and makes a loud whopping sound to forcefully suck air in
62
Q

who is vaccinated against whooping cough?

A
  • Pregnant women are vaccinated against pertussis  becomes less effective a few yrs after each dose
  • within 6 in 1
63
Q

how does whooping cough present?

A
  • Mild coryzal symptoms initially – mild dry cough too
  • Severe coughing occurs after a week or two may have cough free periods – paroxysmal cough
  • Coughing fits are so severe – pt out of breath
  • Loud inspiratory whoop
64
Q

what can hard coughing in whooping cough lead to?

A
  • Hard coughing – fainting, vomiting, pneumothorax, apnoeas
65
Q

what diagnostic tests can be used in whooping cough?

A

: nasopharyngeal/ nasal swab with PCR testing or bacterial culture
- When cough has been present for >2weeks can be tested for anti-pertussis toxin iG

66
Q

what management is needed for whooping cough?

A

inform PHE
- supportive care
- macrolide antibiotics: azithromycin, erythromycin, clarithromycin
- co-trimoxazole is alternative
- close contacts prophylactic antibiotics if in vulnerable group

67
Q

what prophylactic antibiotics are give to close contacts for whooping cough

A

erythromycin

68
Q

what is the prognosis of whooping cough?

A

should resolve within 8wks but can last several months
- 100 day cough

69
Q

what is a key complication of whooping cough?

A

bronchiectasis

70
Q

what is primary ciliary dsykinesia?

A

kartagners syndrome
- Autosomal recessive condition affecting cilia of various cells in body

71
Q

when is primary ciliary dyskinesia more common?

A

within consanguinity families

72
Q

what is the pathophys of primary cilia dsykinesia?

A

Dysfunction of mobility of cilia  leads to build up of mucus in lungs  infection
- Similar pres to CF – frequent and chronic chest infections, poor growth and bronchiectasis

73
Q

apart from effect resp, what else can primary cilia dyskinesia affect?

A
  • Affects cilia in fallopian tubes and tails in flagella of sperm  reduced/ absent fertility
74
Q

what is kartagners triad?

A

seen in primary cilia dyskinesia
Kartagners triad: paranasal sinusitis, bronchiectasis, situs inversus
- Not all pt will have all three but fairly common

75
Q

how do you diagnose primary cilia dsykinesia?

A

recurrent resp tract infections
- Family hx – consanguinity?
- Exam and imaging – CXR to see for situs invertus
- Semen analysis – infertility
- Sample of ciliated epithelium eg nasal brushing or bronchoscopy

76
Q

how do you manage primary cilila dsykinesia?

A

Management: daily physio, high calorie diet and prophylactic AB

77
Q
A

paeds (10 decks)

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