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Y5 Paeds > Noisy Breathing > Flashcards

Noisy Breathing Flashcards

1
Q

What O2 saturation in children is considered low enough to administer oxygen?

A

Below 92%

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2
Q

What RR is considered tachypnoaeic in babies?

A

60+

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3
Q

What is the DDx of a 10 week old baby with running nose and wheeze?

A 
Bronchiolitis 
Croup 
Pneumonia 
Viral-induced wheeze 
GORD
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4
Q

What age range is asthma present in? q

A

Above 5 years old

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5
Q

What age peak is seen in bronchiolitis?

A

12 - 18 months

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6
Q

What are the Sx of bronchiolitis?

A 
High RR 
High HR 
Wheeze 
Runny nose 
Crackles (maybe) 
Difficulty in breathing 
Change in / reduced feeding
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7
Q

Define bronchiolitis

A

Inflammation of the bronchioles caused by RSV

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8
Q

What 2 key questions must be asked regarding bronchiolitis?

A

Has their feeding habit changed?

Are there signs of increased work of breathing?

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9
Q

List signs of increased work of breathing

A 
Nasal flare 
Tracheal tug 
Low O2 sats 
High RR 
Intercoastal / subcoastal recession 
Accessory muscle use
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10
Q

What is classed as a worrying change in feeding? (enough to admit to ward)

A

Eating less than 50% of normal feed amount

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11
Q

What is the usually management for bronchiolitis?

A

Supportive

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12
Q

What other managements can be given in bronchiolitis if needed (and what are the requirements)?

A

NG feed if not feeding

O2 if O2 sats <92%

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13
Q

What risk factors increase severity of bronchiolitis?

A 
Prematurity 
Maternal smoking in pregnancy 
Maternal smoking in first 6 weeks of life 
Previous NICU admission 
Congenital heart condition
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14
Q

List DDx for a 2 year old with barking cough and hoarse voice of sudden onset

A 
Croup 
Foreign body inhalation 
Laryngiomalacia 
Acute epiglottis 
Allergy / anaphylaxis
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15
Q

What is croup?

A

Inflammation of the URT causing obstruction due to parvoinfluenza

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16
Q

What is the peak age of croup?

A

2 years old

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17
Q

What Ix should be done for ?croup ?

A

Inspection for signs of increased work of breathing
Chest examination - inc auscultation
Obs - RR, O2

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18
Q

What is the definitive sign that would change Mx of croup?

A

Stridor

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19
Q

If stridor is heard in croup, what classification does this give it?

A

Moderate or severe

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20
Q

What is stridor?

A

Audible inspiratory wheeze

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21
Q

If stridor is present, what does this represent?

A

URT obstruction

22
Q

What is the Mx of croup?

A

1st line = dexamethasone

2nd line = nebulised adrenaline

23
Q

What dose of dexamethasone is given in mild croup?

A

Between 0.015mg/kg or 0.3mg/kg

24
Q

What dose of dexamethasone is given in severe croup?

A

0.6mg/kg

25
Q

What is the maximum dose of dexamethasone that can be administered?

A

4mg

26
Q

What Ix should you NOT do in croup and why?

A

ENT

Will distress the child and further damage the airway

27
Q

What features differentiate croup from acute epiglottis?

A

AE has no preceding fever
AE child looks sick, but croup child doesn’t
AE child doesn’t speak much but drools a LOT

28
Q

Give the safety netting appropriate for a croup patient

A

Croup cough can take up to 6 weeks to go away

Come back to A&E if decreased RR, cyanosis or less wet nappies

29
Q

What does BIBA stand for?

A

Brought in by ambulance

30
Q

What are resp red flags in a child?

A

Can’t finish a sentence
Increased RR
Wheeze
Low O2 sats

31
Q

What are the DDx for a 6 year old child with known asthma who presents with sudden onset cough, high RR and wheeze?

A

Acute exacerbation of asthma
Foreign body inhalation
Anaphylaxis
Viral induced wheeze

32
Q

What is viral induced wheeze?

A

Viral infection then wheezing

33
Q

What is the age peak of viral induced wheeze?

A

Under 5 years old

34
Q

What is viral induced wheeze similar to?

A

Asthma

35
Q

What can induce an asthma attack?

A

Smoke, pollen, pets, exercise and viruses

36
Q

What is the name of immediate Mx for asthma exacerbation?

A

Burst Tx

37
Q

What is burst Tx? (with doses/timings)

A

Salbutamol (10 puffs) & ipratropium bromide (2 puffs)

Repeat 3 times, once every 10 minutes

38
Q

What are the 4 next line treatments to administer in asthma if burst Tx does not work?

A 
First reassess child's obs / chest 
Add oral prednisolone 
Add IV hydrocortisone 
Add magnesium sulfate 
Add IV aminophylline
39
Q

What are possible complications of magnesium sulfate?

A

Changes in BP

40
Q

What are possible complications of aminophylline IV?

A

Arrythmia, raised heart rate, heart problems

41
Q

What is included in a personal asthma plan?

A

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

42
Q

What details of asthma history are needed in a personal asthma plan?

A

How often do they get Sx?
How often are they using blue inhaler?
Any triggers at home eg smokers / pets?

43
Q

What would a known asthmatic be discharged from hospital with following acute exacerbation of asthma?

A

Blue inhaler to use regularly on a reducing scale for 3 days
Brown inhaler
Community asthma nurse follow up

44
Q

What would a new asthmatic be discharged from hospital with following acute asthma episode?

A

Blue inhaler to use regularly on a reducing scale for 3 days
Community asthma nurse follow up
Maybe peak flow at GP / PEFR test

45
Q

What are the peak ages for the 3 common causes of noisy breathing in children?

A

12 - 18 months = bronchiolitis
0 - 5 years = viral wheeze
5+ years = asthma

46
Q

What must be done to all children who present with noisy breathing?

A

Assess chest inc obs and auscultation

47
Q

What must you find out about in a ?bronchiolitis patient?

A

Is the child off their feed?

Any signs of increased work of breathing?

48
Q

What must you find out about in a ?croup patient?

A

Stridor

49
Q

What is optiflow?

A

Humidified oxygen

50
Q

What is the benefit of optiflow?

A

Can give higher flow of O2 as its nicer on the mucosal membranes when warm

51
Q

What Ix would you do if someone presented with acute asthma ?

A 
Obs: RR, HR, temp, O2 sats
Respiratory exam 
Peak flow 
VBG 
Bloods: CRP, FBC
52
Q

What is the Tx ladder for acute asthma ?

A 
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

Y5 Paeds (13 decks)

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