Noisy Breathing Flashcards
What O2 saturation in children is considered low enough to administer oxygen?
Below 92%
What RR is considered tachypnoaeic in babies?
60+
What is the DDx of a 10 week old baby with running nose and wheeze?
Bronchiolitis Croup Pneumonia Viral-induced wheeze GORD
What age range is asthma present in? q
Above 5 years old
What age peak is seen in bronchiolitis?
12 - 18 months
What are the Sx of bronchiolitis?
High RR High HR Wheeze Runny nose Crackles (maybe) Difficulty in breathing Change in / reduced feeding
Define bronchiolitis
Inflammation of the bronchioles caused by RSV
What 2 key questions must be asked regarding bronchiolitis?
Has their feeding habit changed?
Are there signs of increased work of breathing?
List signs of increased work of breathing
Nasal flare Tracheal tug Low O2 sats High RR Intercoastal / subcoastal recession Accessory muscle use
What is classed as a worrying change in feeding? (enough to admit to ward)
Eating less than 50% of normal feed amount
What is the usually management for bronchiolitis?
Supportive
What other managements can be given in bronchiolitis if needed (and what are the requirements)?
NG feed if not feeding
O2 if O2 sats <92%
What risk factors increase severity of bronchiolitis?
Prematurity Maternal smoking in pregnancy Maternal smoking in first 6 weeks of life Previous NICU admission Congenital heart condition
List DDx for a 2 year old with barking cough and hoarse voice of sudden onset
Croup Foreign body inhalation Laryngiomalacia Acute epiglottis Allergy / anaphylaxis
What is croup?
Inflammation of the URT causing obstruction due to parvoinfluenza
What is the peak age of croup?
2 years old
What Ix should be done for ?croup ?
Inspection for signs of increased work of breathing
Chest examination - inc auscultation
Obs - RR, O2
What is the definitive sign that would change Mx of croup?
Stridor
If stridor is heard in croup, what classification does this give it?
Moderate or severe
What is stridor?
Audible inspiratory wheeze
If stridor is present, what does this represent?
URT obstruction
What is the Mx of croup?
1st line = dexamethasone
2nd line = nebulised adrenaline
What dose of dexamethasone is given in mild croup?
Between 0.015mg/kg or 0.3mg/kg
What dose of dexamethasone is given in severe croup?
0.6mg/kg
What is the maximum dose of dexamethasone that can be administered?
4mg
What Ix should you NOT do in croup and why?
ENT
Will distress the child and further damage the airway
What features differentiate croup from acute epiglottis?
AE has no preceding fever
AE child looks sick, but croup child doesn’t
AE child doesn’t speak much but drools a LOT
Give the safety netting appropriate for a croup patient
Croup cough can take up to 6 weeks to go away
Come back to A&E if decreased RR, cyanosis or less wet nappies
What does BIBA stand for?
Brought in by ambulance
What are resp red flags in a child?
Can’t finish a sentence
Increased RR
Wheeze
Low O2 sats
What are the DDx for a 6 year old child with known asthma who presents with sudden onset cough, high RR and wheeze?
Acute exacerbation of asthma
Foreign body inhalation
Anaphylaxis
Viral induced wheeze
What is viral induced wheeze?
Viral infection then wheezing
What is the age peak of viral induced wheeze?
Under 5 years old
What is viral induced wheeze similar to?
Asthma
What can induce an asthma attack?
Smoke, pollen, pets, exercise and viruses
What is the name of immediate Mx for asthma exacerbation?
Burst Tx
What is burst Tx? (with doses/timings)
Salbutamol (10 puffs) & ipratropium bromide (2 puffs)
Repeat 3 times, once every 10 minutes
What are the 4 next line treatments to administer in asthma if burst Tx does not work?
First reassess child's obs / chest Add oral prednisolone Add IV hydrocortisone Add magnesium sulfate Add IV aminophylline
What are possible complications of magnesium sulfate?
Changes in BP
What are possible complications of aminophylline IV?
Arrythmia, raised heart rate, heart problems
What is included in a personal asthma plan?
Make sure child / parent knows how to use blue inhaler +/- spacer
Make sure parent knows the correct dose of blue inhaler
Take a detailed Hx of asthma triggers and advise if any positive
What details of asthma history are needed in a personal asthma plan?
How often do they get Sx?
How often are they using blue inhaler?
Any triggers at home eg smokers / pets?
What would a known asthmatic be discharged from hospital with following acute exacerbation of asthma?
Blue inhaler to use regularly on a reducing scale for 3 days
Brown inhaler
Community asthma nurse follow up
What would a new asthmatic be discharged from hospital with following acute asthma episode?
Blue inhaler to use regularly on a reducing scale for 3 days
Community asthma nurse follow up
Maybe peak flow at GP / PEFR test
What are the peak ages for the 3 common causes of noisy breathing in children?
12 - 18 months = bronchiolitis
0 - 5 years = viral wheeze
5+ years = asthma
What must be done to all children who present with noisy breathing?
Assess chest inc obs and auscultation
What must you find out about in a ?bronchiolitis patient?
Is the child off their feed?
Any signs of increased work of breathing?
What must you find out about in a ?croup patient?
Stridor
What is optiflow?
Humidified oxygen
What is the benefit of optiflow?
Can give higher flow of O2 as its nicer on the mucosal membranes when warm
What Ix would you do if someone presented with acute asthma ?
Obs: RR, HR, temp, O2 sats Respiratory exam Peak flow VBG Bloods: CRP, FBC
What is the Tx ladder for acute asthma ?
MODERATE 1) Salbutamol inhaler with spacer 2) 3 days oral pred 30-40mg on discharge SEVERE 1) O2 via non re-breathe if low O2 sats 2) Nebulised salbutamol 5mg 3) Add nebulised ipratropium bromide 0.25mg 4) Add oral prednisolone 30-40mg OR IV hydrocortisone 100mg if not tolerated 5) PICU / anaesthestics input 6) IV salbutamol 1-5mg/kg/min infusion 7) IV magnesium sulfate 40mg/kg/20mins 8) IV aminophylline 1mg/kg/hour infusion 9) Intubation
