Lower Respiratory Infection Flashcards
Bronchiolitis:
Pathogens?
When is it most common?
RSV
Parainfluenza
<9 months
Bronchiolitis:
How long is the prodrome and what do you get?
S+S
What would you hear on ausculatation?
1-3 days coryzal prodrome with clear secretions
Wet or dry cough
Respiratory distress - apnoea may occur if <4 months
Fever
Poor feeding and dehydration
Wheeze
Bilateral fine end-inspiratory crackles
Bronchiolitis:
How is it diagnosed?
How do you assess severity?
What can confirm pathogen?
What would be done for severe disease?
Clinical
SATS O2
PCR of nasopharyngeal aspirate
Bloods
Blood gas
CXR
Bronchiolitis:
Management
Most common Rx
When is suction needed?
What if O2 SATS are low?
What if in resp failure?
Why is salbutamol not used in children between 2 yrs?
Conservative
Suction secretions if causing respiratory distress or feeding difficulties
Humidified O2 through nasal cannula or headbox
CPAP or mechanical ventilation
The long acting beta 2 agonists are ineffective however can be used for short acting beta 2 agonists in asthma attacks.
Pneumonia:
What pathogen is responsible in neonates?
What if < 5 yrs?
Group B strep
Strep pneumo, Hib, Strep pneumo
Pneumonia:
S+S
Ausculation
Pathogen specific signs for viral and bacterial
Rx
General URTI signs 1st
High fever
Respiratory distress
Malaise and poor feeding
Bronhial breathing and unilateral coarse end-inspiratory crackles
Wheeze
Abdo or neck pain if bacterial
Amoxicillin PO 7 days
IV if very young or very ill
Whooping cough:
What does it account a lot for?
How does it first present?
What is that followed by?
Then?
When is it often worse?
How long can it last?
Perisistent coughs in school age kids even if vaccinated
Typical URTI first
Followed by paraxysmal stage - episodes of prolonged hacking cough
Inspiratory whoop +/- red face, bulging eyes, vomiting and syncope
At night
3 months
Whooping cough:
Management:
Meds - 1
Prophylaxis
When can they return to school?
Macrolide PO if <3 wks of onset
Prophylactic macrolide to all household contacts
3 days after starting Rx
TB:
When to suspect TB?
S+S?
Overseas contacts
HIV+ve
Odd CXR
Anorexia Low fever Failure to thrive Malaise Cough
TB:
Diagnosis
Tuberculin tests
Interferon-gamma release assays
Culture
CXR
TB:
Rx
3 meds
Get expert help
Isoniazid
Rifampicin
Pyrazinamide
Signs of respiratory distress in children
Hints:
RR HR Nose Mood Chest Muscles Any noises and why?
Increased RR and HR
Nasal flaring
Agitation
Recession/retraction - subconstal, intercostal and sternal
Accessory muscle use - scalenes and SCM
Grunting - expiratory noise due to an attempt to maintain PEEP (look up)
Signs of respiratory failure
Hints:
RR HR O2 Alertness Colour
Low
Low
Low O2 SATS
Somnolence - drowsiness/sleepiness
Cyanosis
What is wheeze?
Differentials?
Use VITAMIN CDEF
A coarse, expiratory whistling sound - suggests LRTI
V I - Broncholitis, pneumonia (including aspiration), viral wheeze T - inhaled foreign body A - asthma, milk allergy MIN CDE
F - Tracheomalacia
What does fine crackles indicate?
When does it usually occur in breathing?
In what circumstance can fine crackles be heard in expiration?
What would you hear in bronchiolitis?
What would you hear in pneumonia?
Inflammation in small airways - bronchioles - (COARSE CRACKLES IS MORE BRONCHIAL)
Inspiration
If there are voluminous secretions
Bilateral, fine end inspiratory crackles
Uni/bilateral coarse crackles
