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EMERGENCIES Flashcards

1
Q

D/d for Stridor

A

Foreign Body Aspiration
Infections

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2
Q

Presence of Stridor Indicates?

A

An upper airway obstruction

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3
Q

Stridor + Fever. Dx?

A

Likely an Infective upper airway obstruction.
Likely Infections: Epiglottitis, Laryngotracheobronchitis

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4
Q

What causes Epiglotitis?

A

A bacterial infection.
Most Commonly: Haemophilus influenza

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5
Q

Presentation of an Epiglotitis Patient

A

Stridor, very high fever
Patient will be in Tripod Position
More serious than Croup
Causes complete obstruction of upper airway within a few hours.

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6
Q

What is Tripod Position? In what instance can we see this?

A

Patients with Epiglotitis use this position.
Seated leaning forward, neck extended, mouth open.

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7
Q

Initial Management of an epiglotitis patient.

A

Do not disturb the child
Ask mother to keep oxygen mask on child’s face.
Do not examine throat, do not cannulate
Call anaesthetist and ENT Surgeon
Send the child to theatre or ICU
Intubation in Theatre
If it fails, a tracheostomy should be done by the ENT Surgeon.
Put a canula and start IV antibiotics (Cefotaxime, ceftriaxone)
When child gets better, Take tube out and send to ward.

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8
Q

What antibiotics are used for the Mx of Epiglotitis?

A

Ceftriaxone
Cefotaxime

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9
Q

What causes Croup?

A

Acute larygnotracheobronchitis is caused by a viral infection,
Parainfluenza virus.

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10
Q

Presentation of Croup

A

Stridor, Low grade fever, Barking Cough

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11
Q

Presentation of Mild Croup and Severe Croup

A

Mild Croup - Stridor, Barking Cough, No respiratory difficulty
Severe Croup - Barking Cough, Stridor, Cyanosis, Breathing difficulty

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12
Q

Mx of croup

A
  1. Steroids
    a. Inhaled/ Nebulized: Budesonide (Pulmicort)
    b. Oral: Dexamethasone (Commonly given), Prednisone
    c. IV: Hydrocortisone
  2. Adrenaline Nebulization (Used as a vasoconstrictor)
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13
Q

What’s the difference in Mx of mild and severe croup?

A

In Mild croup Mx - Steroids first, then Adrenaline nebulization if no response to steroids.
In Severe croup - Mx begins with Adrenaline Nebulization

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14
Q

A child presents with barking cough, fever and stridor. Initial Mx of Steroids followed by adrenaline nebulization yielded no response. What’s the likely diagnosis?

A

Psuedocroup: Bacterial tracheitis.

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15
Q

What causes Pseudocroup?

A

Staphylococcus aureus

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16
Q

Mx of pseudocroup

A

Cloxacillin
Flucloxacillin
Vancomycin

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17
Q

Reduced breath sounds in one side until proven otherwise is?

A

Foreign body aspiration

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18
Q

Child presenting with sudden onset stridor while eating peanuts. What’s the most likely diagnosis?

A

Foreign body aspiration

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19
Q

Mx of a child presenting with FB Aspiration

A

If FB clearly visible in mouth, take it out in direct vision (Blind finger sweeping is not advised).
If FB not visible but child can cough, encourage coughing.
If coughing does not bring FB out or child does not cough - Back blows, chest thrusts, abdominal thrusts.
If that does not work, cricothyroid puncture.
If that does not work, Tracheostomy
If that does not work, Bronchoscopy

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20
Q

Child comes in unconscious, Diagnosed as FB aspiration. What’s the Mx?

A

CPR

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21
Q

What are the X-Ray changes in a FB aspiration causing Complete obstruction?

A

Affected lung will collapse due to no air and the trachea will deviate to the side of obstruction.

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22
Q

What are the X-Ray changes in a FB aspiration causing incomplete obstruction?

A

Affected lung will be hyperextended. Trachea deviates to the opposite side.

Hyperexpansion - Since inspiration is an active process and expiration is passive, while air comes in not all air comes out collecting air leading to hyperexpansion.

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23
Q

Is it a good practice to always do a X-Ray for FB aspiration? Why?

A

No.
Most of the FB’s are not visualized in X-Rays.

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24
Q

Dx of patients with unilateral rhonchi and B/L Rhonchi.

A

Unilateral - FB unitl proven otherwise
B/L - Asthma until proven otherwise

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25
Q

Initial assessment of a 6 year old asthmatic presenting with difficulty in breathing.

A

A brief history - From the mother
Examine child - Auscultate for rhonchi, Check respiratory rate and HR.

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26
Q

What’s the purpose of checking RR and HR in the initial assessment of a known asthmatic with difficulty in breathing?

A

To differentiate between simple asthma and severe asthma.

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27
Q

What are the Cut-offs of RR and HR for Severe asthma?

A

<5yrs: HR > 130bpm RR > 50/min
>5yrs: HR > 120bpm RR > 30/min

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28
Q

6 year old. Known Asthmatic. B/L Rhonchi. HR - 140bpm. RR - 55/min. What’s the most likely Dx?

A

Acute severe asthma.

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29
Q

How are the lung sounds “Rhonchi” formed?

A

Due to the bronchoconstriction of the airways which causes a turbulent flow.

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30
Q

Differentiate between acute severe asthma and life threatening asthma.

A

Acute severe asthma
HR and RR above cut-off, No cyanosis, Low CO2 levels, Patient active, pH increased (Alkalosis)

Life threatening Asthma
HR and RR reduced, cyanosed, High CO2 levels, patient is drowsy, pH decreased (acidosis, SILENT CHEST (No Rhonchi)

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31
Q

Why are there no Rhonchi in Life threatening Asthma?

A

Due to complete obstruction of airway.

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32
Q

What happens when Acute severe asthma is not managed properly or at all?

A

Due to broncho-constriction,
Low Oxygen and High CO2 - Affects brain, casues drowsiness.
High CO2 - Acidosis - Supresses heart and lungs.
Low O2 - Cyanosis, Bluish Fingers

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33
Q

What are the 2 methods of asthma Mx?

A

Reducing inflammation
Broncho-dilation

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34
Q

Types of Bronchodilators used in Asthma MX

A

Nebulized - Salbutamol, Ipratropium Bromide
Injections - Salbutamol, Aminophyllin, MgSO4

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35
Q

Types of Steroids used in Asthma Mx

A

Oral - Prednisone, Dexamethasone
IV - Hydrocortisone

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36
Q

Mx of Acute Severe Asthma

A
  1. Nebulize with salbutamol + O2 - 3 times back to back nebulization. Time interval is time taken to refill liquid.
    If child gets better (No rhonchi on auscultation) with 1st & 2nd doses, 3rd is not required.

If no Response
2. Nebulize with Salbutamol + Ipratropium Bromide.
Give a steroid as well - IV Hydrocortisone, Oral prednisone.

If no Response
3. IV MgSO4
4. Salbutamol/Aminophyllin IV
5. Chest X-Ray and Blood gas
If normal but child is not getting better - 6. Send to ICU for mechanical ventilation.

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37
Q

Is the efficacy of IV hydrocortisone and Oral Prednisone same/different?

A

The efficacy is the same.

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38
Q

Mx of Life threatening asthma

A

Same as mx of acute severe asthma, but begins with step 2.

  1. Nebulize with Salbutamol + Ipratropium Bromide.
    Give a steroid as well - IV Hydrocortisone, Oral prednisone.

If no Response
2. IV MgSO4
3. Salbutamol/Aminophyllin IV
4. Chest X-Ray and Blood gas
If normal but child is not getting better - 5. Send to ICU for mechanical ventilation.

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39
Q

Adverse effects of drugs used in the Mx of Asthma

A

Salbutamol and Aminophylline casues increased Beta 2 Receptor activation leading to SNS over activity.
Salbutamol - Tremors, Tachycardia, Hypokalemia (Results in increased K+ intake by cells)
Aminophyllin - Arrythmia, seizures

MgSO4 - Hypotension, Respiratory arrest due to neurodepression.

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40
Q

(T/F)
1. Most seizures will settle within 7 minutes.
2. IV diazepam is the best benzodiazepine for generalized tonic clonic seizures
3. CBS and an ABG should be done during a seizure.
4. Most common cause of seizures in children is fever
5. Patients with snake bites can become unconscious
6.Phenobarbitone can cause arrhythmias.
7.Time duration between 2 PR diazepam doses is 10 minutes.

A
  1. F ( 5 minutes)
  2. F (IV Lorazepam > Midazolam
    > Diazepam)
  3. F (Only CBS)
  4. T ( Febrile convulsions)
  5. T
  6. F ( Respi arrest)
  7. T
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41
Q

Ideal position to keep an epileptic patient mid seizure

A

Left lateral position

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42
Q

Initial Mx of generalized tonic clonic seizure

A

Left lateral position
Suck out secretions
Give Oxygen
Check CBS

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43
Q

Anti- epileptic routes

A

1.iv ( BEST)- Lorazepam, Midazolam, Diazepam
2.PR (USUALLY USED)- Diazepam
3. Buccal mucosa
4. Intranasal
5.IM

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44
Q

PR diazepam dose

A

0.5mL/kg

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45
Q

PR diazepam can be repeated …. times

A

two

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46
Q

PR Diazepam cannot be repeated more than twice because

A

can cause respiratory arrest

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47
Q

Diazepam, Midazolam, lorazepam belongs to ( drug class)

A

Benzodiazepines

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48
Q

Final step in status epilepticus Mx if drugs fail

A

Send to ICU for paralysis and ventilation

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49
Q

During the seizure which drug route should be secured

A

iv - best route to deliver anti- epileptics fast

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50
Q

Anal atresia patient presents with status epilepticus and iv access cannot be secured, best drug route

A

buccal - midazolam

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51
Q

Benzodiazepine preference order if iv access is gained

A

Lorazepam > Midazolam > Diazepam

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52
Q

Status epilepticus Mx of a patient

A

1.Keep the patient in the left lateral position
2.Clear secretions from the mouth with a suction machine
3.Give Oxygen
4.Check CBS
5.Wait for five minutes to see if the episode settles. Meanwhile try and get the iv access.
6.If the episode doesn’t settle, and iv access wasn’t obtained, give anti- epileptics through another route ( PR diazepam , IM, buccal, intranasal midazolam)
7.Wait for 10 minutes and if there’s no improvement repeat.
8. No improvement- give PR Paraldehyde
9.Send the child to ICU for paralysis and ventilation

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53
Q

Status epilepticus Mx if IV access is gained

A

1.Keep the patient in the left lateral position
2.Clear secretions from the mouth with a suction machine
3.Give Oxygen
4.Check CBS
5.Wait for five minutes to see if the episode settles. Meanwhile try and get iv access.
6. Give a BZ
7. Wait five minutes
8. Repeat if no improvement
9.Give iv Phenobarbital/ Phenytoin Na
10. Send to ICU for Paralysis and ventilation

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54
Q

ADRS of Midazolam (BZs)

A

Respiratory arrest

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55
Q

ADRS of Phenobarbital

A

Respiratory arrest

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56
Q

ADRS of Phenytoin Na

A

Arrhythmia

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57
Q

What needs to be done before giving Phenobarbitone

A

Call the ICU and make sure a bed is available

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58
Q

What needs to be done before giving Phenytoin Na

A

Connect the child to a cardiac monitor

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59
Q

How to choose between Phenytoin and Phenobarbital if iv access is gained

A

depends on the child’s drug Hx.
Give the drug, the child wasn’t prescribed

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60
Q

Causes of seizures in children

A

Fever
Hypoglycemia
Reduced Na+, Mg2+, Ca2+
Meningitis

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61
Q

A child admitted to the ICU for treatment for meningitis develops seizures, best drug to give

A

iv Lorazepam

62
Q

Ideal Systolic BP for a 9 year old

A

80 + (9x2) = 98mmHg

63
Q

An unconscious 9 year old, BP 100/75mmHg, PR 88/min, Breathing normal. Immediate Mx?

A

Check if the airway is patent
Start Oxygen
Check CBS
Rest depends on the possible cause

64
Q

Possible causes of unconsciousness

A

Hypoglycemia
Head trauma
Snake bites
Cerebral Edema

65
Q

An unconscious 9 year old, BP 100/75mmHg, PR 88/min, Breathing normal. CT shows cerebral edema. Mx?

A

Check if the airway is patent
Start Oxygen
Check CBS
Prop the head- end of the bed by 20 degrees
Keep the neck straight
Start diuretics ( Mannitol)

66
Q

What is the initial assessment of a child presenting with sudden onset unconsciousness?

A

A - Airway patent: Talk to child, see for response
B - Feel warmth of breath, look for chest movements
C - Check central pulses: Carotid, Brachial, Femoral

67
Q

An unconscious child with no palpable central pulses and no breathing movements, what’s the most likely Dx?

A

Cardiopulmonary arrest

68
Q

Initial management of a Child that is cardiopulmonary arrested

A

Keep airway patent: Triple manoeuvre - Head tilt, chin lift, jaw thrust
Mouth-to-mouth breathing
Start chest massage

69
Q

After the initial Mx of the cardiopulmonary arrested child, what follows in the ETU?

A

Connect to cardiac monitor
Start bag and mask ventilation
Continue cardiac massaging - 15 massages : 2 breaths
After 2mins of massaging adrenaline can be administered,
Dose - 1 : 10,000 0.1ml/kg IV/IO
Every 3mins of massaging, adrenaline can be given
General cardiac massaging is continued for 20mins

70
Q

What are the types of shocks?

A

Cardiogenic shock - Due to cardiac arrest, Cardiac arrythmias
Hypovolemic shock
Maldistributive shock - Anaphylactic shock, septic shock

71
Q

What is the other name for Irregular broad complex bizzare tachycardia?

72
Q

How do you manage V. Fib?

A

De-fibrillating Shock
soon after the shock, CPR must be commenced.
After 2mins of CPR, if rhythm is not back to normal, shock can be repeated.
There is also a place for other drugs - Adrenaline, Amiodarone

73
Q

How are the pedals of the defibrillator placed on a child and a neonate?

A

Child - One pedal under the R/Clavicle, Other on top of heart
Neonate - One pedal on heart, the other on the back.

74
Q

Can a patient be left connected to a cardiac monitor while being shocked?

A

If the cardiac monitor is DC-shock compatible, Yes.
If not, Must be disconnected.

75
Q

What is known as SVT?

A

Supraventricular tachycardia.
Narrow complex tachycardia & tachycardia with no P waves.

76
Q

How do you calculate the HR from a ECG?

A

300/R-R intervals

77
Q

How do you differentiate SVT from Sinus Tachycardia?

A

SVT - If <2yrs HR > 220
If >2yrs HR >170
P waves absent

Sinus Tachy - If <2yrs HR < 220
If >2yrs HR < 170
P waves present

78
Q

SVT Mx

A
  1. Vagal Manoeuvres - Immersion of face in Ice (More suitable for infants)
    Unilateral Carotid massage
    Val Salva Manoeuvre - Forced expiration against closed glottis. (Best method for small children)
  2. If that doesn’t work, see if child is in shock,
    If Yes - DC Shock
    If No - Adenosine, Amiodarone
78
Q

How is Adenosine administered?

A

It has a very short life. It should be administered as a rapid injection from a vein near to the heart followed by a normal saline flush.

79
Q

How do you calculate the normal Systolic BP?

A

80 + (Age * 2)

79
Q

13yrs old 40Kg child with severe diarrhea and vomiting for 5 days presented with drowsiness. PR - 160/min. BP - 70/40mmHg. CRT - 5s. What is the most likely Dx?

A

Hypovolemic Shock.

79
Q

How do you initially approach Hypovolemic shock?

A
  1. Put 2 cannulae and then give a crystalloid - Normal saline 20ml/kg RAPID BOLUS (Squeeze bottle)
  2. If no impovement - repeat Normal saline 20ml/kg rapid bolus.
  3. If no impovement - Give a colloid.
  4. If no impovement, Give a vasoconstrictor - Adrenaline
80
Q

What are the types of Colloids?

A

Dextran, Hetastarch, Blood

81
Q

In general practice, why isn’t a colloid given as the first step of Mx of Hypovolemic Shock?

A

Expensive
Remains in circulation for a long time
Can cause anaphylaxis by reacting

82
Q

A child developed difficulty in breathing and faintishness while on a blood transfusion. What’s the most likely Dx?

A

Anaphylaxis/ Anaphylactic shock

83
Q

What are the features of anaphylaxis?

A

Rhonchi on auscultation
Vasodilatation leading to reduced blood supply to brain causing faintishness
Swelling
Itching
Stridor- laryngeal edema

84
Q

Mx of anaphylaxis due to a blood transfusion

A

Stop blood transfusion immediately
IM adrenaline 0.01ml/kg 1 : 1000
If child is having rhonchi, nebulize with salbutamol
Fluid boluses can be given
To prevent the recurrence, steroids like hydrocortisone can be given
Chlorpheniramine can be given.

85
Q

How can anaphylaxis be managed at home

A

If patient has an adrenaline pen, give dose as an injection

Adrenaline can be given through clothes

86
Q

Difference in adrenaline doses during cardiac arrest and anaphylaxis

A

Cardiac arrest - IV/IO 1 : 10,000 0.1ml/kg

Anaphylaxis - IM. 1 : 1000 0.01ml/kg

87
Q

A 3yr old presenting with a wide spread rash and very high fever. BP 65/30mmHg. PR 160/min. CRP 70 (Normal upto 6). What’s the most likely Dx?

A

Septic Shock.

Low BP + Fever

88
Q

Septic Shock Mx

A

Same as Hypovolemic Shock + Antibiotic
1. Normal Saline 20ml/kg as a rapid bolus
2. Repeat if no response.
3. Use a colloid if no response.
4. Use vasoconstrictors if no response.

89
Q

What are the types of antibiotics used in the Mx of Septic shock?

A

Cefotaxime
Ceftriaxone

90
Q

Which organism can cause a wide spread purple rash?

A

Neisseria meningitides

91
Q

most venomous snakes

A

Cobra - Naya
Common krait
Sri Lankan krait - karawala
Russel’s viper - polanga
Saw- scaled viper

92
Q

Kraits Sx

A

Bites at night
Targeted When the person lies on the floor
Only Neuro Sx

93
Q

Cobra Sx

A

Neuro Sx
Local Sx

94
Q

Viper Sx

A

Blood, neuro, Kidney, local bite site Sx

95
Q

Anti venom comes in what form

A

white coloured powder form

96
Q

Immediate step in snake bite

A

Reassure and calm the child. ( To prevent accelerated systemic spread of the venom)

97
Q

Early signs of systemic envenomation

A

Nausea
Vomiting
Abd Pain

98
Q

Test done in snake bites

A

WBCT - put 2 mL of blood to a tube and keep for 20 minutes and see if blood has undergone coagulation

99
Q

Steps in a snake bite Mx on- site

A

Calm the child
Wash the bite site with soap
Immobilize the bite site
Send to the hospital

100
Q

Is splinting or tying a tourniquet recommended in snake bite Mx

A

Nopesy. Restricting the blood flow to the bite region which already has undergone necrosis will further accelerate the necrosis.

101
Q

Anti- venom works on…

A

Viper
Kraits
Cobra

102
Q

Anti- venom dose

A

dissolve the powder in 10 mL of water or NS. Give 10 vials (100mL) over one hour

103
Q

Why should the child be closely monitored during anti venom administration

A

High risk of getting anaphylaxis

104
Q

Steps followed if the child goes into anaphylaxis during the third anti- venom vial

A

Stop the transfusion
Manage the anaphylaxis - IM adrenaline (1:1000) 0.01mL/kg
If rhonchi + - salbutamol
Continue the anti venom once stable

105
Q

On what situations of snake bites are anti- venom given

A

If there are signs of systemic envenomation

106
Q

Will all snakes prolong WBCT

A

Nopesy. Krait won’t

107
Q

Steps of snake Mx once in the ETU

A

WBCT
Check for signs of systemic envenomation
Start anti- venom

108
Q

Initial Mx of a dog bite on-site

A

Wash the bite with soap
Take to the hospital

109
Q

Mx of a major dog bite

A

Rabies Ig + Vaccine

110
Q

Mx of a minor bite

A

only the vaccine

111
Q

Rabies vaccine doses given days

A

Given on D0
D3
D7
D14
D28

112
Q

Besides the rabies vaccine what other vaccine is given

A

Tetanus toxoid if the child hasn’t gotten it during the last five years

113
Q

Major exposures of a dog bite

A
  1. Single or multiple bites with bleeding on head, neck, face, chest, upper arms, palms, tips of fingers & toes, genitalia
    2.Multiple deep scratches with bleeding on the head, neck, face
    3..Single or multiple deep bites on any body part
    4.. contamination of mucous membranes with saliva.
  2. Bites of wild animals with bleeding
114
Q

Minor exposures of a dog bite

A

1.Single, superficial bite or scratch with bleeding on the lower limbs, upper limbs, abdomen, neck
2.Nibbling of uncovered skin
3.Contamination of open wounds with saliva.
4. Single or multiple bites or scratches without bleeding on any body part.
5.Drinking raw milk of rabit cow or goat

115
Q

Usual PCM dose

116
Q

Toxic and lethal PCM doses

A

Toxic >100mg/kg
Lethal >200mg/kg

117
Q

How much PCM is there in a PCM syrup bottle

A

120mg PCM in 5mL of the syrup

118
Q

PCM dose per kg for a 30kg child who has ingested 25 tablets of PCM

A

Total PCM dose = 25x500= 12500mg
PCM dose per kg= 12500/30= 416.66mg
Exceeded the lethal dose

119
Q

Mx of PCM OD’d child who came to the ETU in under 1 hour

A

Gastric lavage
Activated charcoal
Check the Blood PCM levels ~4h after ingestion
Start NAC/ Methionine
Test AST/ALT, PT/INR, Blood sugar
Refer the child to a psychiatrist and inform the JMO

120
Q

Gastric lavage in PCM poisoning

A

Take a 100mL syringe and an NG tube
Push water in and aspirate it out
keep repeating until the aspirated fluid appears like only water

121
Q

Activated charcoal process

A

Dissolve in water and send through an NG tube

122
Q

Is the test to check for the PCM doses in blood always done

A

no. not readily available

123
Q

Mx of PCM OD’d child who came to the ETU in 5 hours

A

Take a history from the mothet
Start NAC/ Methionine
Refer to psychiatry and inform the JMO

124
Q

Mx of a child who ingested kerosene oil

A

Careful monitoring of the respiration
Give O2
Do a CXR
Give steroids + ABx w senior opinion
Counsel parents on safe location and inform if this will be repeated that they will be alerted to the police.

125
Q

What steps are not done in kerosene poisoning. Why

A

Gastric lavage and activated charcoal method
Can cause aspiration leading to chemical pneumonitis

126
Q

A 12 year old child presented following an accidental ingestion of a liquid 30 minutes before. He is having diarrhea. Examination revealed B/L pupillary constriction. Most likey Dx

A

Organophosphate poisoning

127
Q

Sx of Organophosphate poisoning

A

DUMBBELSS
Diarrhea
Urination
Miosis
Bradycardia
Bronchoconstriction
Emesis
Lacrimation
Secretions
Salivation

128
Q

Mx of Organophosphate poisoning

A

Remove contaminated clothes
Suck out secretions
If the patient came <1h do a lavage or use the activated charcoal with senior opinion
Give atropine
Give pralidoxime if atropine doesn’t work

129
Q

Mechanism of Organophosphate poisoning

A

Organophosphate blocks the activity of Acetylcholine esterase causing accumulation of Ach.
Accumulated Ach causes hyperstimulation of Muscarinic and nicotinic receptors. leading to a cholineregic crisis

130
Q

Features of atropinization after Mx of Organophosphate poisoning

A

Reduced muscarinic effects-
No diarrhea, vomiting
Urinary retention
Mydriasis
Tachycardia/clear lungs
No tears
Dry mouth/ Dry armpits

131
Q

7/12 baby presents w cough, cold and mild fever for 4/30. He has a runny nose. Today mother has noticed the baby is struggling to breathe. Dx?

A

Bronchiolitis

132
Q

Bronchiolitis

Common age group of presentation

133
Q

Bronchiolitis

causative MO

134
Q

Bronchiolitis

Sx

A
  • Mild fever
  • cough
  • cold
  • dyspnea from 4th-5th day
135
Q

Bronchiolitis

How long does mild fever, cough, cold last

A

usually a week

136
Q

Bronchiolitis

When does dyspnea develop

A

first 1-3 days will be fine. During the 4-5th days they will come to a peak in difficulty in breathing and usually they will get better.

137
Q

Bronchiolitis

How do they present

A

Presents w
* mild fever
* cough
* cold
* nasal blockage and discharge
* dyspnea
* small children can have a small period of apnea

138
Q

Bronchiolitis

DDs

A
  • Pneumonia
  • if the child >2 years- asthma
  • URTI
139
Q

Bronchiolitis

Why is asthma not usually considered to be a DD for Bronchiolitis

A
  • if the child is <2 years highly unlikely
  • usually asthma does not present w fever
140
Q

Bronchiolitis

What are the likely examination findings

A
  • fever
  • runny nose
  • blocked nose
  • features of dyspnea- tachypnea, intercostal recessions, dehydrated
  • Rhonchi, crepitations on auscultation
141
Q

Bronchiolitis

Ix

A
  • CXR
  • Naso- pharyngeal aspirate
  • FBC
  • ABG
142
Q

Bronchiolitis

CXR findings

A
  • horizontal ribs ( due to air trapping, chest hyper inflates)
  • Hyperinflated lung ( flat diaphragm)
  • Inflammatory shadows
  • Hyperlucent chest- dark lung fields
143
Q

Bronchiolitis

why is naso- pharyngeal aspirate done

A

to look for RSV

144
Q

Bronchiolitis

FBC findings

A

increased WBC w predominant lymphocytes

145
Q

Bronchiolitis

Mx

A
  • Suck out secretions
  • normal saline nasal drops for nasal blockage
  • NG feeding, iv fluids if not feeding properly
  • O2 via face mask if hypoxic
  • Some may need breathing support- high flow O2
146
Q

Bronchiolitis

Prevention is done by

A

RSV vaccine

147
Q

Bronchiolitis

If the child is going into respi failure. Mx

A
  • will need intubation and mechanical ventilation.
  • If child is not very ill- can nebulize w normal saline
  • salbutamol nebulization is not proven to be effective. You can give- some may improve, others might not
  • Streoids, ABx not given

PAEDIATRICS (15 decks)

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