LRTIs in Children Flashcards
What are the principles of managing a child with an LRTI?
Make a diagnosis.
Assess the patient.
Oxygenation, hydration, and nutrition are all top priorities.
Treatment.
What are common symptoms of LRTIs?
Fever, SOB, cough, grunting.
Wheezing (if bacterial cause is unlikely).
Reduced or bronchial breath sounds.
What is tracheitis?
Uncommon - ‘croup that does not get better’.
A febrile, sick child.
Harsh coughing, worsening stridor, hoarse voice.
Caused by Staph or Strep.
Treated with Augmentin.
What is bronchitis?
A common, self-limiting, endobronchial infection.
A loose rattly cough with a URTI, followed by post-tussive vomits (gluts). Lasts ~10 days.
No wheeze or creps.
Caused by Pneumococcus or Haemophilus.
The child is often well, but the parent is worried.
What is bacterial bronchitis?
Caused by a disturbed mucociliary clearance (minor airway malacia, RSV, adenovirus).
What is persistent bacterial bronchitis?
Usually follows URTIs, lasts <4 weeks.
Cough morbidity decreases each winter.
If persistent - reassure and do not treat.
What is bronchiolitis?
Usually caused by RSV (peaks at the end of December). Not a recurrent infection.
Symptoms include nasal stuffiness, tachypnoea, poor feeding, crackles, and wheeze (~2 weeks).
How do you manage bronchiolitis?
Maximal observation, minimal intervention.
Medications do not work in bronchiolitis.
What are the investigations of bronchiolitis?
Nasopharyngeal aspiration (NPA - identifies the virus).
Oxygen saturations (to determine severity).
When do you diagnose pneumonia?
Signs are focal (in one area).
Crepitations.
High fever.
Otherwise, call it an LRTI.
The name causes great anxiety.
What are the investigations of pneumonia?
CXR - not routine, only used to confirm.
Mild symptoms - no management.
First line - oral amoxicillin.
Second line - oral macrolide.
IV if vomiting.
When are oral antibiotics used?
When antibiotics are indicated in non-severe LRTIs; when the child is not vomiting.
What are the benefits of using oral antibiotics compared to IV antibiotics?
Shorter hospital stays.
Cheaper.
However, the fever does last a few more hours.
What is empyema?
A complication of pneumonia.
Extends infection into the pleural space.
Causes chest pain and general illness.
Treat with IV antibiotics and drainage.
What is pertussis?
Common - vaccinations reduce risk and severity, not chance.
Symptoms include - coughing fits, vomiting, and colour change.
