Difficulty Breathing Flashcards
What is a paroxsysmal cough?
Frequent and violent coughing that can make it hard for a person to breathe
Acute severe asthma: Findings on inspection
Severe Recession; SC, IC, Tracheal Tug
Posture sitting forward - ‘tripod position’
(intermittent wheeze)
Acute severe asthma: Findings on palpation
Hyperexpanded chest
Symmetrical Expansion
Poor expansion if severe
Central trachea, cardiac apex in usual position
liver pushed down; edge palpable
Acute severe asthma:
Percussion and Auscultation
Resonant but equal
Air entry symmetrical
Poor entry indicates increasing severity
Severe pneumonia:
Findings on inspection
Respiratory distress with recession and tracheal tug
Wet cough; +/- grunting
Severe pneumonia:
Findings on palpation, percussion and auscultation
Asymmetrical if severe unilateral pneumonia
Dullness over consolidation
Reduced air entry
Bronchial breathing/crackles over the area of infection
Pneumothorax:
Findings on Inspection
Signs of inc resp effort - recession asymmetrical chest expansion
PTX:
Findings on palpation, percussion, auscultation
Asymmetrical chest expansion
Trachea may be deviated and cardiac apex displaced (IF TENSION)
Hyperresonant
No air entry on the affected side
Cardiac failure:
Findings on inspection
Tachypnoea with little recession
Cardiac failure:
palpation, percussion auscultation
Symmetrical expansion
Liver enlarged
Resonant, symmetrical
Creps over both lung bases
Heart murmur may be present
Differences in child and adult resp exams
Increased emphasis on looking for signs of increased respiratory effort and respiratory distress
What is Harrison’s Sulci?
Horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm
Usually caused by chronic asthma or obstructive respiratory disease
Organs affected by Cystic Fibrosis
Sinuses (sinusitis)
Lungs (mucus, bacterial infection, widened airways)
Skin (salty sweat)
Liver (blocked biliary duct )
Pancreas (blocked pancreatic ducts)
Intestines (cannot fully absorb nutrients)
Reproductive organs (male and female complications)
Assessing severity of wheeze or exacerbation of asthma
Agitation/Conciousness ?hypoxia
Exhaustion - accessory muscles, cyanosis
RR, HR, BP, O2, PEF
Severity of attack
Moderate:
- PEFR at least 50% of best, normal speech (none of below)
Severe:
- PEFR <50% of best
- RR >25 (12y) >30(5y) >40 (2-5y)
- Pulse - 110, 125, 140
- Inability to complete sentences
Life threatening:
- PEFR <33%
- O2 <92%
- altered consciousness, exhaustion, cardiac arrhythmia, hypotension, cyanosis, poor respiratory effort, silent chest, confusion
Factors that lower threshold for hospital admission
Born prematurely
Significant medical history
Ability of carers to cope (experience, level of anxiety, time available)
Treatment while awaiting hospital admission
O2 Treat with β2 agonist: - life threatening: salbutamol nebs - use pressurised metered-dose inhaler with spacer up to 10 puffs Monitor PEFR and O2
Treatment if admission not required
SABA to relieve acute symptoms
If good response to SABA prescribe PRN
Prescribe short course oral Pred if existing/suspected asthma
Prescribe Abx (Amoxicillin)
Self care advice
Follow up child within 48 hours of presentation
Life expectancy with CF
Early 50s
What are adenoids?
Glands located behind the soft palate
Produce antibodies and WBC
Shrink during adolescence
Three key problems in asthma
Airway obstruction
Inflammation
Smooth muscle hyperplasia
Non atopic/Intrinsic causes of asthma
Aspirin Stress Exercise Cold Occupation toxins
Cells in the respiratory system
Pseudostratified columnar epitheleum
Layers of the mucosa in the respiratory tract
Epitheleum
Basement membrane
Lamina Propria
(Smooth muscle
Submucosa)
Effects of histamine in asthma
Results via IgE mediated allergens
Acts on smooth muscle and stimulates mucus production (cough in astma)
Effects of CF on male reproductive system
Can have absent Vas deferens
Reduced fertility
Primary immune cells involved in asthma
TH2
Eosinophils
Interleukins released by TH2 in asthma
IL4 - causes B cells to produce IgE ->
IL5
(IL13)
Pathophys of Asthma following initial exposure (Immediate)
Primed mast cells release mediators - prostaglandins, leukotrienes, interleukins
Release of ACh due to vagus stimulation (smooth muscle contraction)
Mast Cells in LP:
Produce chemoattractants, attracting neutrophils, eosinophils
Release Leukotriene C4, B4 E4 (lipooxygenase pathway) - brochoconstriction, blood vessel dilation (oedema), stimulate mucus glands
Release prostaglandins (PGD2) - bronchoconstriction, mucus production (COX pathway)
Pathophys of Asthma (Late)
Further antigens are not necessary for late phase reaction
IL5 produced by B cell and mast cells activate eosinophils
Eosinophils release Major Basic Proteins (Cationic) and cause inflammation
Leads to resp epitheleal damage
Airway Remodelling in Asthma
Curshmann spirals
Charcot-Leyden crystals
Lamina Propria thickening
Muscle hyperplasia
What are Curshmann spirals?
Spiral-shaped mucus plugs from subepithelial mucous gland ducts of bronchi
What are Charcot-Leyden crystals?
Microscopic crystals composed of eosinophil protein galectin-10 found in people who have allergic diseases such as asthma or parasitic infections such as parasitic pneumonia or ascariasis
What is the commonest lung infection in children?
Acute broncheolitis
What are the causes of acute broncheolitis?
Respiratory syncytial virus (RSV)
Mycoplasma
Parainfluenza
Adenoviruses
Symptoms of acute broncheolitis
Coryza precedes cough Fever (sometimes) Tachypnoea Wheeze Inspiratory crackles
Apnoea
Recession
Cyanosis
