Foreign body/obstruction Flashcards
Etiology of wheezing
- RSV and other viruses can cause airway inflammation leading to wheezing
- many wheezy kids don’t have asthma
- bronchodilators and steroids don’t really help with viral wheezing
Asthma Pathophys
hetergeneous condition –> inflammation of airways, mucus hypersecretion, reversible airflow obstruction with bronchodilators
Asthma symptoms
recurrent coughing and wheezing that is responsive to bronchodilators or steroids
Asthma triggers and diagnosis
Triggers - URI, allergens, cold, exercise, smoke
Diagnosis - responds to therapy and has no other explanation
Asthma vs Reactive Airway Disease
some people like to use RAD instead of using asthma in very young kids because they don’t want to label them as asthmatics if they truly do not have asthma
Signs of respiratory distress
Paradoxical breathing - force of contraction exceeds ability of chest wall to expand (chest drawn inward during inspiration) Tachypnea Subcostal retractions Nasal Flaring Grunting Head bobbing
Most serious and worrisome sign of respiratory distress?
Paradoxical breathing
Interventions for respiratory distress
Blow-by oxygen, nasal cannula, mask, or ETT
Causes of wheezing in toddlers
Common - Viral bronchiolitis, asthma, foreign body, GERD
Uncommon - tracheomalacia, compression, CF
Causes of coughs in toddlers
viral illness, pneumonia, post-nasal drip, foreign body, GERD
Key history info for cough
Still drinking? Fever? Sudden onset? Hoarse voice or cry? Barky cough? Other problems? Immunizations? Sick contacts? Smoke exposure?
DDx for infant with cough
Allergies, asthma
Bronchiolitis, croup, PNA, pertussis
foreign body, sinusitis, anatomic abnormality
Viral URI, GERD, CF
Extrinsic causes of wheezing
Vascular ring or sling
adenopathy
mass or lesion
Key findings on lung exam
Stridor - airway narrowing ABOVE thoracic inlet (usually inspiration)
Wheezing - airway narrowing AT thoracic inlet (mucus plugging, asthma)
Rhonchi - coarse, low-pitched rattling sound
Crackles - inspiration, fluid in alveoli
Air entry - should be noted on every exam
Asymmetric breath sounds
unilateral airway obstruction –> think foreign body, PTX, atelectasis
Evaluation for foreign body
- PA and lateral chest films
2. Bilateral decubitus inspiratory/expiratory films
Radiographic findings of asthma
hyperinflation of lungs due to airway trapping, increased interstitial markings, patchy atelectasis
Treatment of asthma
beta-2 agonists, corticosteroids, could have inhaled corticosteroids
Prognosis dependent on severity of disease and adherence to medication regimen
Bronchiolitis
viral disease of lower respiratory tract
- bronchiolar obstruction due to inflammation and edema (mucus and cellular debri)
- RSV, influenza, parainfluenza
- low grade fever, cough, tachypnea, congestion
Bronchiolitis radiographic findings
hyperinflation, increased interstitial markings, peribronchial cuffing, scattered atelectasis
Treatment of bronchiolitis
supportive –> maintain oxygenation and hydration
Pneumonia
inflammation of lung parenchyma
Viral - adenovirus, RSV, influenza, parainfluenza
Bac - GBS, e. coli (neonates), chlamydia (4-12), strep pneumo (rest)
Signs and symptoms of pna
fever, cough, tachypnea, low O2 sats, malaise
- crackles on lung exam
Treatment of PNA
Viral - supportive
Bac - amoxicillin (80-90 mg/kg split BID)
Radiographic findings of PNA
Viral - “fluffiness” and patchy infiltrates
Bac - consolidated opacity or infiltrates in specific lobes
Sequelae of foreign body
Irritative objects can result in more inflammation –> pneumonitis or erosion of healthy tissue
If total airway obstruction –> medical emergency
