LRTI Flashcards
Is the trachea upper or lower respiratory tract?
Lower
What is tracheitis?
Uncommon
“croup which does not get better”
How does tracheitis present?
Fever
Sick child
What causes tracheitis?
BACTERIA
Staph or strep invasive infection
How does tracheitis present on endoscopy?
Swollen tracheal wall
Narrowed tracheal lumen
Luminal debris
How is tracheitis treated?
Augmentin
What is bronchitis?
Common ++++
Endobronchial infection
How does bronchitis present?
Loose rattly cough with URTI
Post-tussive vomit - “glut”
Chest free of wheeze/creps
What causes bronchitis?
Haemophilus/Pneumococcus
How is bronchitis treated?
Mostly self-limiting
Child VERY well, parent worried
What is the mechanism of bacterial bronchitis?
Disturbed mucociliary clearance
- Minor airway malacia
- RSV/adenovirus
Bacterial infection/overgrowth is secondary
What is the cycle associated with child LRTI?
Respiratory virus -> Clearance stops for <4 weeks -> Cough and rattle -> Clearance almost recover ->
What is the natural history of bacterial bronchitis?
Following URTI (e.g. rhinovirus infection)
Lasts 4 weeks
60-80% respond to antibiotic (must consider side-effects)
First winter bad
Second winter better
Third winter fine
Pneumococcus/H flu
How do you manage persistent bacterial bronchitis?
Make the diagnosis
Reassure
Do not treat
What is bronchiolitis and how does it present?
LRTI of infants
Affects 30-40% of all infants
Nasal stuffiness!!
Tachypnoea
Poor feeding
Crackles +/- wheeze
What is the causative organism in bronchiolitis?
Usually RSV (respiratory syncynctial virus)
Others include:
Paraflu III
HMPV - Human metapneumovirus
What are the diagnosing factors of bronchiolitis?
12 months old
One off (NOT recurrent)
Typical history
How is bronchiolitis managed?
Maximal observation
Minimal intervention
How is bronchiolitis investigated?
NPA - nasopharyngeal aspirate (nursing in same ward) Oxygen saturations (severity)
No routine need for
- CXR
- Bloods
- Bacterial cultures
Which medications are not proven to work in bronchiolitis?
NO MEDICATIONS WORK!! Salbutamol Ipratropium bromide Adrenalin Steroids Antibiotics Nebulised hypertonic saline
What are the markers of a LRTI?
48 hrs, fever (>38.5oC), SOB, cough, grunting
Wheeze makes bacterial cause unlikely
Reduced or bronchial breath sounds
“Infective agents” - Virus+commensal bacteria/bacterium
What is the timeline of bronchiolitis?
Days 2-5: gets worse
Days 5-7: stabilises
Days 7-14: recovery
How do you decide if it’s pneumonia?
Totally academic! (does the child care??)
Word causes great anxiety
You might call it pneumonia if:
- Signs are focal, ie in one area (LLZ)
- Creps
- High fever
Otherwise call it LRTI
What can an x-ray do in LRTI?
Confirm diagnosis BUT DOESN’T CHANGE WHAT YOU DO
What are the BTS guidelines for investigating community-acquired pneumonia?
CXR and inflammatory markers not routine
What are the BTS guidelines for managing community-acquired pneumonia?
Nothing if symptoms are mild
(always offer to review if things get worse!)
1) Oral Amoxycillin first line
2) Oral Macrolide second choice
3) Only for iv if vomiting
PNEUMOINIA - IV AMOXCILLIN
Why use oral antibiotics over IV?
Shorter hospital stay
Cheaper
When:
- antibiotics are indicated (48 hours, etc, etc)
- in non-severe LRTI
- when child is not vomiting
Why use IV antibiotics over oral?
Fever for a few more hours
When:
- antibiotics are indicated (48 hours, etc, etc)
- in non-severe LRTI
- when child is not vomiting
What are the differences between LRTI and bronchiolitis?
Technically same thing
LRTI:
- In all ages
- More rapid onset of symptoms
- Fever
BRONCHIOLITIS:
- Aged <12 months
- 3 days before reach peak
- Fever rarely >38oC
LRTI GUIDANCE
What is pertussis?
Whooping cough
This is common!
Vaccination reduces risk
Vaccination reduces severity
What are the signs of pertussis?
“Coughing fits”
Vomiting and colour change
What is empyema?
Complication of pneumonia
Extension of infection into pleural space
What are the signs of empyema?
Chest pain and very unwell
What is the management of empyema?
Antibiotics+/- drainage Good prognosis (in contrast with adults)
What do you do first in all LRTIs?
Oxygenation, hydration and nutrition
Summary
LRTI SUMMARY
