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Paediatrics > Lower Respiratory Tract Infections in Children > Flashcards

Lower Respiratory Tract Infections in Children Flashcards

1
Q

LRTI is infection distal to the _______

A

larynx

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2
Q

Principles of management:

  • Make a diagnosis (____)
  • Assess the patient (____) - Oxygenation, hydration, nutrition
  • To treat or not to treat (____)
A

easy

easy

grey - Biggest dilemma is to weather to treat or not

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3
Q

Putting LRTI into context - how common are they?

A

More than a third of all admissions of all hospitals, of all children to all hospitals in Scotland in 2018 were explained by upper and lower respiratory tract infection

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4
Q

what is Tracheitis?

A
  • Uncommon
  • “croup which does not get better”
  • Fever, sick child
  • Staph or Strep invasive infection
  • Augmentin
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5
Q

what is Bronchitis and what are the symptoms?

A
  • Common ++++
  • Endobronchial infection
  • Loose rattly cough with URTI
  • Post-tussive vomit - “glut” (sputum)
  • Chest free of wheeze/creps
  • Haemophilus/Pneumococcus
  • Mostly self-limiting
  • Child VERY well, parent worried
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6
Q

what is the mechanism of Bacterial bronchitis?

A

•Disturbed mucociliary clearance

  • Minor airway malacia
  • RSV/adenovirus
  • Lack of social inhibition!
  • Bacterial infection/overgrowth is secondary

Virus switches of mucociliary clearance

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7
Q

Bronchitis:

So what happens in winter is……

A

Common for child to have 4 or 5 cycles of this in winter

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8
Q

how long may a cough last?

A
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9
Q

what is the natural history of Bacterial bronchitis?

A
  • Following URTI
  • Lasts 4 weeks
  • 60-80% respond (antibiotics)
  • First winter bad
  • Second winter better
  • Third winter fine
  • Pneumococcus/H flu
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10
Q

Persistent bacterial bronchitis: what is the management?

A
  1. Make the diagnosis
  2. Reassure
  3. Do not treat
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11
Q

Bronchiolitis – a clinical diagnosis

what is it?

(Different form bronchitis (infection of large airways). As this is infection of small airways)

A
  • LRTI of infants
  • Affects 30-40% of all infants
  • Usually RSV, others include paraflu III, HMPV
  • Nasal stuffiness, tachypnoea, poor feeding
  • Crackles +/- wheeze
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12
Q

Not many conditions that are as predictable as bronchiolitis - what does the progression of it look like?

A

If you see them at day 3 and they are bad then admit to hospital as you know they will get worse but if you see them at day 5 and their oxygenation and hydration are fine then you know tomorrow they wont be any worse

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13
Q

what is the duration of bronchiolitis?

A
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14
Q

when about does bronchitis occur?

A

Comes at Christmas

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15
Q

Bronchiolitis:

  • <12 months old
  • One off (___ recurrent)
  • Typical _______….
A

12 (Condition of infancy)

NOT

history

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16
Q

what is the Management of bronchiolitis?

A
  • Maximal observation
  • Minimal intervention
17
Q

what investigation can be done for bronchiolitis?

A

a clinical diagnosis

  • NPA (nursing in same ward) (identify what the virus is)
  • Oxygen saturations (severity)
  • No routine need for - CXR, Bloods, Bacterial cultures
18
Q

what Medications proven to work in bronchiolitis?

A

none

19
Q

Lower respiratory tract infection - what are the typical features?

A
  • 48 hrs (history of), fever (>38.5oC), SOB, cough, grunting
  • Wheeze makes bacterial cause unlikely
  • Reduced or bronchial breath sounds
  • “Infective agents” - Virus+commensal bacteria/bacterium
20
Q

if a patient presents, Is it pneumonia or not?

A
  • Totally academic! (does the child care??)
  • Word causes great anxiety
  • You might call it pneumonia if:
  • Signs are focal, ie in one area (LLZ – left lower zone)
  • Creps
  • High fever

•Otherwise call it LRTI (or chest infection)

21
Q

should you x-ray in pneumonia?

A

Regardless of these x-rays, the management is exactly the same

This is the chest X-ray of a child with a 48 hour history of fever, cough, shortness of breath, and is treated with amoxicillin

22
Q

BTS guidelines – community acquired pneumonia

what are the guidlines?

A
  • Investigations - CXR and inflammatory makers (e.g. CRP, BC) NOT “routine”
  • Management:
  • Nothing if symptoms are mild (oxygen and hydration normal)
  • (always offer to review if things get worse!)
  • Oral Amoxycillin first line
  • Oral Macrolide second choice (if allergic to amoxycillin)
  • Only for iv if vomiting
23
Q

iv versus oral antibiotics:

When:

  1. antibiotics are indicated (48 hours, etc, etc)
  2. in non-severe LRTI
  3. when child is not vomiting

If child fills 3 criteria, then they get away with oral antibiotics - why is oral better than IV?

A

Oral antibiotics “win” 2:1

√ Shorter hospital stay

√ Cheaper

X Fever for a few more hours

24
Q

What is the difference between LRTI and bronchiolitis?

A

Both technically the same thing

bronchiolitis has a 12 month age limit

25
Q

what is Pertussis? and what does it cause?

(whooping cough)

A
  • This is common!
  • Vaccination reduces risk
  • Vaccination reduces severity
  • “Coughing fits”
  • Vomiting and colour change
26
Q

what is Empyaema?

A
  • Complication of pneumonia
  • Extension of infection (from lung tissue) into pleural space
  • Chest pain and very unwell
  • Antibiotics+/- drainage
  • Good prognosis (in contrast with adults)
27
Q

To treat or not to treat?

A

First sort out oxygenation, hydration and nutrition (people die because of hypoxia, dehydration, and malnutrition so sort that first then worry about antibiotics)

Then worry about antibiotics!

*2 days fever, cough, focal signs (ie one side)

28
Q

Take home messages:

  • LRTI are common in children
  • Oxygenation, hydration and nutrition
  • Then think about antibiotics
  • Review if needed
A

Paediatrics (36 decks)

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