LRTI Flashcards
What is epiglottitis generally associated with
H. influenza type B
Which population is epiglottitis most common in
urban male in 40s
What is occurring in the body with epiglottitis
bacteria colonize the nasopharynx and spread locally causing supraglottic cellulitis
What are the 4 Ds of epiglottitis presentations in children
Drooling
Dysphagia
Dysphonia
Distressed respiratory effect
What signs are seen with adults with epiglottitis
Tripod position
sore throat
dysphagia
drooling
What are signs of toxicity from lack of air
Poor or absent eye contact
failure to recognize parents
cyanosis
irritability
inability to be consoled/distracted
What on PE should raise suspicion for epiglottitis
Severe throat pain with a normal appearing pharynx
if a child is tripoding, are they stable or unstable
stable.. but does mean they will probably crash soon
What is the dx and workup for epiglottitis
CBC and blood cultures
direct inspection
Culture epiglottis
lateral neck XR
Where should direct inspection of the epiglottis be preformed
In the OR to confirm diagnose and secure the airway
When may stridor occur outside of epiglottitis
Croup
bacterial tracheitis
airway foreign body
When may tripod position occur outside of epiglottitis
peritonsillar or retropharyngeal abscess
What type of trauma may lead to epiglottitis
caustic ingestion
thermal injury
What is the treatment for epiglottitis in children
Admit to hospital
How do you get a definitive diagnosis of epiglottitis
flexible fiberoptic laryngoscope
What will be seen with a laryngoscope in epiglottitis
beefy, red, stiff, edematous epiglottis
How long should an ETT be left in with epiglottitis
for 24-48 hours post stabilization of patient
What is the treatment of choice for epiglottitis
Ceftriaxone
*once extubated PO augmentin will be sent home with them
What is another name for laryngotracheobronchitis
croup
If a child has a fever, cough, stridor, and hoarseness, what is their likely diagnosis
Croup
What is the common cause of croup
parainfluenza virus
Which gender is more commonly effected by croup
Boys
what is the common age for croup
12months-2years
What time of year is croup most common
October to early spring
What is the most narrow part of an airway in kids under 8
subglottic space
What does a cough sound like with croup
Barky seal like cough
What are common things seen with croup
drooling
dysphagia
stridor w/o cough or fever
incomplete immunizations
What will you see on xray with croup
steeple sign
How do you diagnose croup
rule out other causes of stridor.. mostly a clinical diagnosis
What are differentials for croup in kids <6 month
Subglottic stenosis
vocal cord paralysis
hemangioma
foreign body aspiration
anaphylaxis
What are differentials for kids > 6months
Foreign body aspiration
bacterial tracheitis
epiglottitis
peritonsillar abcess
abscess
anaphylaxis
If a patient has a barky cough with or without stridor at rest, how do you treat
supportive measures
What is mild croup and how do you treat
barky cough w/ or w/o stridor with agitation
One dose steroids then d/c home
What is moderate croup and how do you treat
barky cough and stridor at rest, w or w/o increased work of breathing
Steroids
nebulized api with 3hour observation
What is severe croup and how do you treat
Barky cough, stridor, prominent increased work to breathe
Steroids, nebulized epi with 3 hour observation and then reassess… possible admission
What is the goal of croup treatment
reduce airway obstruction
What is heliox
Breathing gas mixture of helium and O2
When is bacterial tracheitis seen
Fall and winter months
What population is most effected by bacterial tracheitis
Males
children
6months - 14 years (peak 3-8)
What viruses can cause bacterial tracheitis
influenza
parainfluenza
RSV
What is bacterial tracheitis
Bacterial infection of trachea, generally after a viral URI
What are common bacterial that may cause bacterial tracheitis
Staph aureus
s. pneumonia
strep pyogenes
H. influenza
What are the 2 ways bacterial tracheitis present
1) sx are present for 1-3 days until severe airway deterioration from overlapping infection
2)Usual treatment of croup is/has been ineffective
What are common symptoms of bacterial tracheitis
Respiratory distress
appear toxic if fulminant
severe insp./exp. stridor
raspy voice but NO dysphagia
How do you get a definitive diagnosis of bacterial tracheitis
Direct laryngoscopy
How do you treat bacterial tracheitis
admit to ICU
aggressive airway management
Antibiotics (ceftriaxone + Nafcillin)
humidified O2
What are red flags for respiratory failure
hypoxia
retractions
fatigue
AMS
decreased breath sounds
How long are kids generally hospitalized with bacterial tracheitis
3-12 days
What is the leading cause of hospital admission in infants under 1y/o
Bronchiolitis
What is the most common cause of bronchiolitis
RSV
What is a common complication of bronchiolitis and how do you treat it
Recurrent wheezing
Inhaled corticosteroids and leukotriene antagonists
What time of year is bronchiolitis most common
autumn and winter
What are risk factors for bronchiolitis
low birth weight
<5months
Airway anomalies
Parental smoking
Crowded living environment
Chronic lung disease
What are the risk factors for severe bronchiolitic infections
Premature birth
<3months
neuromuscular disease
congenital heart disease
chronic lung illness
immunodeficiency
What will occur in the lungs with bronchiolitis
air trapping
increased mucus production
atelectasis
labored breathing / decreased ventilation
What is the course of infection with bronchiolitis
Initial URI sx
Within 48-72hrs lower airway in involved
respiratory distress
illness lasts 7-10 days and most infants improve in 14-21 days as long as they’re hydrated
What are mild respiratory distress symptoms with bronchiolitis
tachypnea
What is severe respiratory distress symptoms in bronchiolitis
retraction’grunting
cyanosis
What will be seen on PE with bronchiolitis
crackles/wheezing/rhonchi
grunting
nasal flaring
retractions
How do you get a clinical diagnosis of bronchiolitis
RSV wash
What are differentials for bronchiolitis
asthma
bacterial pneumonia
GERD
croup
foreign body aspiration
pertussis
What is the hallmark treatment for bronchiolitis
symptomatic care
How do you treat mild-moderate bronchiolitis symptoms
nasal saline
antipyretics
cool-mist humidifier
How do you treat severe bronchiolitis symptoms
beta agonist (albuterol)
neb of hypertonic saline
mechanically ventilate w/ resp failure
How can you try to prevent bronchiolitis
passive immunization against RSV (palivizumab)
What is the prognosis of bronchiolitis
self limited
What are the causative organisms for pertussis
bordetella pertussis
Bordatella parapertussis
How is pertussis spread
airborne droplets (highly contagious)
What are some presentations of pertussis
petechiae above nipple line from increased thoracic pressure from coughing
What test is used for diagnosis of pertussis
Nasopharyngeal culture and PCR
takes 3-7 days
What is a classic pertussis finding on Xray
shaggy right heart border
What may be seen on labs with pertussis
leukocytosis
What are key differentiating factors for pertussis
persistent cough without fever
typical progression through 3 phases
What is the tx of pertussis
mostly supportive
Strict isolation through contagious phase
What is the post exposure prophylaxis for family members of those with pertussis
erythromycin
Which patients with pertussis should be hospitalized
pneumonia
hypoxic
CNS complications
unable to tolerate hydrationPO
Which patients do you hospitalize with pertussis regardless of symptoms
patients <1y/o who are not fully vaccinated
What antibiotics can be used with pertussis
Erythromycin (first line)
If a patient with pertussis has a fever in the paroxysmal phase, what are you concerned for and why
Pneumonia
because fever should resolve in catarrhal phase
What are common complications of pertussis
Superimposed pneumonia
Otitis media
Pulmonary HTN
What is acute bronchitis secondary to
virsuses
*bacterial infection highly uncommon
When is acute bronchitis commonly seen
during flu season
Which population is at higher risk for acute bronchitis
current/past smoker
hx asthma
living in polluted place
crowding
If acute bronchitis is bacterial, what is the cause
p. pneumonia
What is the predominant complaint of acute bronchitis
cough
What kind of mucus will patients have with acute bronchitis
clear/yellowing +/- purulent
What is the other name for pertussis
Whooping cough
How long does a cough with acute bronchitis typically last
10-20 days (avg around 18days)
How do you treat acute bronchitis
symptomatic treatment
-hot tea/honey
-mucolytic
-b-agonist
What is the gold standard for diagnosing influenza
PCR or viral culture of throat secretions
How many types of flu are there and which variations infect humans
4 variations
A&B infect humans
When do incidences of of flu generally peak
October - march
Which patients are at higher risk with influenza
Age >65 or 6mo-6yr
Chronic CV/ resp conditions
CKD
Diabetes
Immunocompromised
pregnancy
At what age can you begin the flu vaccine
over 6months of age
If a patient has an egg allergy and only develops hives, should they still get the flu vaccine
yes
* just observe for 10-15 minutes post vaccination
Can pregnant women and elderly receive flu vaccine
Safe for pregnancy
standard vaccine not effecting >65
What is unique to influenza A
Genetically labile with high rates of mutations
How do immune reaction and interferon response present
high fever, coryza, body aches
Where does the virus replicate in the body
upper and lower respiratory passages
peaking at 48 hours
What is the cornerstone of treatment for influenza
supportive w/ fluids
Which variation of influenza can neuraminidase inhibitors be used
both A and B
Which variation of influenza can adamantanes be used
Influenza A only
What are complications of influenza
secondary bacterial pneumonia
ARDS
Myositis
myocarditis
multi organ failure
