Graneto DSA Flashcards
Labs in bacterial tracheitis
may demonstrate a leukocytosis Left shift
What accounts for 90% of stridor with fever affecting children most commonly from 6 months to 3 years?
Laryngotracheobronchitis (croup)
if retropharyngeal abscess presents in older child, it is following what in many instances?
penetrating trauma to posterior oropharynx
When should you give steroids for croup?
as early as possible (dexamethasone)
This is an infection of the subglottic region and is more likely to cause respiratory failure than croup and epiglottitis combined
-give pseudomembrane formation
Bacterial tracheitis
How may patients with upper airway compromise breathe
through an open mouth, which suggest dysphagia with inability to swallow secretions, or the general presence of air hunger
Definite diagnosis of bacterial tracheitis occurs with visualization of what?
normal epiglottis and presence of pus, inflammation, and in some cases a pseudomembrane in subglottic region upon intubation
What are the most common causes of acute upper airway obstruction?
- croup
- epiglottitis
- foreign-body obstruction
Most peritonsillar abscesses are from what microbes
- Group A strep
- Peptostreptococcus
- Fusobacterium
- other mouth flora
What do you do if a child younger than 1 has complete obstruction
4 back blows followed by chest thrusts
What is by far the most reliable sign of respiratory failure in an infant or child?
an ineffective respiratory effort and an altered level of consciousness
What is treatment for croup aimed at
solely at relieving symptoms
What do you give any child with respiratory distress?
supplemental oxygen
Start all patients with suspected retropharyngeal abscess on what antibiotic
clindamycin plus a 3rd gen cephalosporin as empiric treatment
In patients with moderate croup score, whatt will usually result in symptomatic improbement for up to 2 hours
use of oxygen and racemic epinephrine delivered by nebulizer
What are lab findings common with retropharyngeal abscess
leukocytosis with elevated acute phase reactants
What can occur with staphylococcal tracheitis
Toxic Shock syndrome
What is definitive therapy for retropharyngeal abscess?
intraoperative drainage of the abscess in the OR
In most suspected cases of retropharyngeal abscess, what will identify any soft tissue infections and abscess formation
CT scan of neck
What do you do if a child older than 1 has complete obstruction
repetitive abdominal thrusts
What does “hot potato” phonation represent
splinting of the palatine muscles during normal speech
Agents responsible for croup
- Parainfluenza types 1, 2, and 3 (most common)
- adenovirus
- RSV
- influenza
What is the hallmark of upper airway compromise?
Stridor
Most common symptoms and signs of hypoxemia in children?
- agitation
- irritability
- failure to maintain feeding effort
Some cases of Peritonsillar abscess are superinfection of an existent _____
Epstein-Barr infection
what do you give a patient with epiglottitis after intubation
ceftriaxone IV
What may prevent the progression of croup to complete obstruction by decreasing the amount of swelling of laryngeal mucosa
corticosterioids
Describe antibiotic treatment of bacterial tracheitis
Begin broad spectrum that includes coverage of S. aureus with a third gen cephalosporin such as ceftriaxone along with vancomycin until culture results are known
These are seen predominantly in children younger than 3 years secondary to suppurative cervical lymphadenopathy
Retropharyngeal abscesses
most common age group for epiglottitis?
2 to 5
Classic presentation for croup
children usually present after several days of nonspecific upper respiratory infection (URI) symptoms with a characteristic brassy or barking cough
-temperatures common
Age group for peritonsillar abscess
children older than 8
discharge patients with mild croup if what?
- parents are reliable
- child is well hydrated and taking adequate fluids
- child is older than 6 months
presentation of retropharyngeal Abscess
- commonly cervical lymphadenitis and trismus
- stiff neck or torticollis
- often initially thought to be meningitis
What may be necessary in addition to oxygen, epi, and corticosterioids, if croup is severe?
- maybe antibiotics
- maybe intubation
Age group for foreign body aspiration
children under 5
Cyanosis of respiratory origin tends to be what?
central
Are blood cultures useful in bacterial tracheitis?
rarely
position of comfort with epiglottitis
sitting upright, mouth open, with head, neck and jaw in extension
most common microbes causing bacterial tracheitis
- S. aureus
- S. pneumonii
- H. influenza
- psuedomonas
- Moraxella
What is seen on a lateral neck radiograph with bacterial tracheitis
subglottic and tracheal narrowing with a ragged tracheal border secondary to the pseudomembrane
A secondary effect of cyanosis may be the development of what?
somnolence
in a young infant, stridor is most often the result of a congenital anomaly of what 3 things?
- tongue (macroglossia)
- Larynx (laryngomalacia)
- trachea (tracheomalacia)
Chest X ray with bacterial tracheitis
may demonstrate concomitant pneumonia
position of comfort for lower airway disease
assume “tripod position” consisting of upright posture, leaning forward, and support of the upper thorax by use of extended arms
microbes causing retropharyngeal abscess
- Group A hemolytic step
- Staph
- more frequently MRSA
Position of comfort for children with stridor
- upright
- lean forward
- generate own jaw thrust maneuver to open upper airway
What is the most common response of a child to increased respiratory needs?
tachypnea
before sending a child home with mild croup, give dose of what?
oral decadron
usual evolution of croup
worsening of symptoms for 3 to 5 days followed by resolution over a period of days
presentation of of peritonsilar abscess
- increasing dysphagia
- ipsalateral ear pain
- progression to trismus, dysarthria and toxicity
- Drooling common
- “hot potato” phonation
Lateral neck radiographs for retropharyngeal abscess
Prevertebral soft tissue swelling greater than 7 mm at the level of the second cervical vertebrae or greater than 14 mm at the level of the 6th vertebrae and a normal epiglottis and aryepiglottic folds
