Lower Respiratory Tract Infection

Question 1

Principles of management (LRTI)

Answer 1

• Make a diagnosis (easy)
• Assess the patient (easy)
• Oxygenation, hydration, nutrition
• To antibiotics or not (grey area)

Question 2

TRACHEITIS

Answer 2

• Uncommon
• “croup which does not get better”
• Fever, sick child
• Staph or Strep invasive infection
• DOES need antibiotics

Question 3

BRONCHITIS

Answer 3

• EXTREMELY common
• Ages 1-4
• Endobronchial infection
• Loose rattly cough with URTI
• Post-tussive vomit - “glut” (usually creamy/clear)
• Chest free of wheeze/creps
• Haemophilus/Pneumococcus
• Mostly self-limiting

Question 4

How do you differentiate between RSV and asthma/viral wheeze

Answer 4

< 12 months old
One off (not repetitive)
Typical history

Question 5

Management of bronchiolitis

Answer 5

Maximal observation
Minimal intervention

Question 6

Lower Respiratory Tract Infection characteristics

Answer 6

• 48 hrs, fever (>38.5oC), SOB, cough, grunting
• Wheeze makes bacterial cause unlikely
• Younger child less likely to have bacterial cause
• Reduced or bronchial breath sounds

Question 7

EMPYAEMA

Answer 7

• Complication of pneumonia
• Extension of infection into pleural space
• Chest pain and very unwell
• Antibiotics+/- drainage
• Good prognosis (in contrast with adults)

Question 8

TO TREAT OR NOT TO TREAT?

Answer 8

see table in notes!!