Intra-Thoracic Airway Disorders Flashcards
Bronchiolitis
widespread inflammation and obstruction of the bronchioles causing necrosis of the cells lining the airways
most common in infants less than 6 months
occurs in winter and early spring months
caused by viruses (most common = RSV)
transmission: direct contact w/ respiratory secretions
* RSV secretions can survive for up to 30 min on countertops
* all kids by age 3 have had RSV
Bronchiolitis: Pathophysiology
bronchiole mucosa is colonized by viral organisms > necrosis > obstruction w/ old cell debris > edema and mucosa > atelectasis, hyperexpansion of lungs or collapse of alveoli > able to take air in, but difficult to expel air (causing trapping)
Bronchiolitis: Clinical Finding
- URI symptoms (cough, coryza, rhinorrhea)
- gradual development of respiratory distress
- low-grade to moderate fever
- decreased appetite
physical exam findings:
- coryza
- conjunctivitis
- pharyngitis
- otitis media
- tachypnea
- substernal/intercostal retractions
- expiratory wheezing
- fine/coarse crackles
- varying respiratory distress
- apneic spells
Bronchiolitis: Management
- No bronchodilators or antibiotics
- nebulized hypertonic saline for hospitalized infants
- supportive care (hydration, antipyretics)
- O2 if low sat
- fluid intake monitorinig
- nasal suctioning (avoid deep airway suctioning)
Bronchiolitis: Complications
- prolonged apnea
- uncompensated respiratory acidosis
- profound dehydration
- tendency for bronchia hyper-reactivity lasting years
Bronchiolitis: Prevention
palivizumab - for high risk infants
educate caregivers about limiting exposure
Foreign Body Aspiration: Sx
depend on nature of FB, location, degree of obstruction
Laryngeal FB:
- rapid onset of hoarseness/chronic croupy cough
- unilateral wheezing
- recurrent pneumonia
Tracheal FB:
- brassy cough
- hoarseness
- dyspnea
- cyanosis
- homophonic wheeze
Bronchial FB:
- most in right lung
- initial episode of coughing, gaging, choking
- blood-streaked sputum
- limited chest expansion
- decreased vocal fremitus
- atelectasis
- crackles, rhonchi, wheezes
Foreign Body Aspiration: Management
- referral to pulmonary specialist for bronchoscopy
- treat secondary lung infections and bronchospasm
Foreign Body Aspiration: Complications
- vegetal or arachidic bronchitis
- suppuration if material present a long time
- lobar pneumonia, intractable wheezing, status asthmaticus
Foreign Body Aspiration: Prevention
anticipatory guidance/safety
Nonbacterial and Bacterial Pneumonia: Clinical Manifestations
- respiratory distress, apnea, tachypnea
- nasal flaring, grunting, retractions
- tachycardia
- air hunger
- cyanosis
- fine crackles, dullness, diminished breath sounds
bacterial:
- fever
- hypoxia
- lethargy
- splinting affected side
- pleural effusion
Nonbacterial and Bacterial Pneumonia: Management
- supportive care (antipyretics, hydration, rest)
- antibiotics (only if bacterial suspected)
Nonbacterial and Bacterial Pneumonia: Complications
- meningitis
- CNS abscess
- endocarditis
- osteomyelitis
- septic arthritis
- pulmonar complications
