L3 - Respiratory Symptoms & Signs In Children ; The Important Diseases Flashcards
Difference between signs and symptoms ?
We can see signs e.g. swelling
People complain of symptoms e.g. back pain
Define cough
Vital defensive reflex that uses high pressure high volume air flow to clear the respiratory tract of obstruction and noxious substances.
Non- productive cough
Does not bring up mucus or other substances
Describe why you might cough in response to eating a spicy curry?
Capsaicin is a spicy compound.
Type 1 vanilloid receptor / transient potential cation channel subfamily V member 1 (TrpV1) receptor.
- chemo receptor
- sensitive to acid , heat and capsaicin
Examples of where you might find mechanical receptors?
External auditory canal Ear drum Paranasal sinus Pharynx Diaphragm Pleura Pericardium Stomach
Afferent pathway of cough
Sensory fibres of:
- pulmonary
- auricular (Arnold’s nerve)
- pharyngeal
- superior laryngeal
- gastric
- cardiac
- oesophageal branch’s of vagus nerve
Describe efferent pathway of cough?
Vagus , phrenic and spinal motor nerves to diaphragm and abdominal wall muscles
Which nerves give motor control to intercostal muscles?
Phrenic and spinal nerves
Which nerve innervates larynx ?
Laryngeal branch of vagus to larynx
Define Wheeze
Continuous high pitched whistling sound produced in respiratory airway during breathing.
Asthma ?
Inhaled object ?
Describe Rales aka fine crackles ?
- Sounds like rubbing your hair together.
- Indicates fluid in alveoli.
- Bilateral or unilateral ?
Describe Ruttles aka rattily chest?
Coarse
Lower pitch than wheeze
Where might rattles be felt?
Transmitted vibration on posterior chest wall.
Ruttles may be indicative of?
Viral respiratory infection
Describe Rhonchi? (3)
aka large airway sounds
- Coarse
- non-continuous
- popping noise
Large air way sounds may be indicative of what?
Rhonchi
Chunky mucous and pus in large conducting airways.
Often clears with an effective cough.
Describe sound of chronic stridor?
Very coarse, loud breathing
State three causes of chronic stridor?
- Inspiratory
- obstruction in glottis above thoracic inlet - Biphasic
- inflammation of vocal cords - Expiratory
- tracheal obstruction
Laryngomalacia
- Congenital softening of tissues
- of the larynx above vocal cords.
- Tissues to fall over the airway opening
- and partially block it.
Croup
Acute onset stridor.
Exp. loud coarse intermittent barking cough like sound.
Croup caused by…
Viral infection with inflammation of trachea - parainfluenza virus.
Tracheomalacia
- Flaccidity of supporting tracheal cartilage.
- Widening of posterior membranous wall.
- Cause tracheal collapse, especially in times of increased airflow.
What might be observed in a child with epiglottitis?
- Inspiratory harsh sound on every breath.
- Child sitting forward.
- Neck extended.
Epiglottitis typically caused by…
non Haemophilus influenzae type b vaccinated child.
Describe the urgency of epiglottitis
MEDICAL EMERGENCY. PARA-ARREST CRISIS - call for urgent help & ENT - do not lay flat - do not cannulate
Describe pleural friction rub?
Footsteps in snow, crump crump.
Very localised on chest wall.
Associated with chest wall pain ‘pluerisy’
Dyspnoea
Diseased, difficult breathing
Signs of dyspnoea
Rapid breathing Chest wall indrawing in young children. Tracheal tug Head bobbing Child can't finish sentences.
Describe other causes of increased respiratory rate
- Fever / Pain
- Infection due to hypoxic drive or hypercapnia
- Metabolic acidosis
Haemoptysis
Coughing up blood.
Costochondritis
typically seen in:
- Pain, tenderness sites of sternum at parasternal joints.
- Presumed inflammation of rib cage cartilage.
- Typically age 12-14 y/o , girls more likely to have it than boys.
Cause costochondritis
cause unknown.
May be due to viral infection.
Tietze syndrome
Pain, swelling and tenderness at parasternal joints
Occurs in adolescents and adults < 40 y/o
Summarise some common URTIs
Ottitis media - middle ear infection PAIN FEVER
Tonsilitis - PAIN FEVER FOETOR
Pharyngitis - PAIN FEVER
Coryza - Nasal mucous congestion and discharge with sneezing
Summarise some common LRTIs
Bronchitis
Bronchiolitis
Pneumonia
Pneumonitis
Common signs bronchitis (2)
Cough
- May be productive
Rhonci
Common signs of bronchiolitis
Cough, crackles and wheeze
Pneumonia clinical signs (3)
- Crackles
- Wheeze
- dullness
Pneumonitis signs
Crackles
Be aware of common organisms causing RTI deaths in children
Streptococcus pneumoniae
Haemophilus influenzae
Respiratory syncytial virus
Human Metapneumovirus
Adenovirus
Influenza
Pneumonia signs
COUGH + RAPID / DIFFICULT BREATHING
Severe pneumonia
Not able to drink, persistent vomiting, convulsions, lethargic, stridor in calm child. Severe malnutrition
Treating severe pneumonia
Oxygen!
IV penecillin
IV gentamicin
(5 days approx)
Treating pneumonia
Oral amoxicillin
3 days
Pneumonia investigations
- Pulse oximetry
- Early warning scores
Why might you assess urea and electrolytes in severely ill patients with pneumonia?
to assess SIADH
- syndrome of inappropriate antidiuretic hormone secretion.
State some microbiological investigations which may be done as part of a pneumonia investigation?
Nasopharyngeal aspirate - RSV rapid test, multiple viral detection assays.
Cough swap, sputum culture.
Lung aspiration.
Antigen detection.
Antibody detection - virus , chlamydia and mycoplasma
Antibody detection in pneumonia investigation for: (3)
- Virus
- chlamydia
- mycoplasma
General management of pneumonia in UK?
Maintain oxygen.
Antipyretics and analgesics
Maintain fluid intake
IV fluids in severe patients.
Examples of macrolide antibiotics
Erythromycin, Azithromycin and clarithromycin.
When may macrolide antibiotics be used?
If mycoplasma or chlamydia pneumonia is suspected.
Empyema
Medical term for pockets of pus that have collected inside body cavity.
Causes of empyema
lil culprits
S pneumoniae
S aureus
Group A streptococci
H influenza (Rare)
Fungal/ mycobacterial infections in immunosupressed patients.
Treatment of empyema
IV antibiotics Chest drain: large or pigtail Urokinase: break down fibrin bands Mini thoracotomy Decoritcation
Decortication
- Surgical removal of the surface layer, membrane or fibrous cover of lung.
- Performed when lung is covered by thick, inelastic pleural peel
- restricting lung expansion.
