Paediatric airway/respiratory conditions Flashcards
Breakdown of causes of respiratory failure
Congenital and acquired
Extra-thoracic/intra-thoracic/Resp drive
Congenital causes of respiratory failure
Extra-thoracic:
- laryngomalacia
- Subglottic stenosis
- Tracheomalacia
- Vascular ring
- Cystic hygroma
- Craniofacial anomalies
Intra-thoracic
- Cogenital lung disorders (CDH, congenital lobar emphysema)
- CCAM
- Surfactant protein B & C deficiency syndromes
- Alveolar capillary dysplasia
Resp drive:
- SMA
- Congenital hypoventilation syndrome
- Congenital myotonic dystrophy
- Congenital myasthenia gravis
- Eventration of diaphragm
- Duchennes
Acquired causes of respiratory failure
Extra-thoracic:
- Infection (croup, RP abscess)
- Trauma
- Other - hypertrophied tonsils
Intra-thoracic
- Infection
- Heart failure (TAPVD)
- Asthma
- Near drowning
- ARDs
- BOOP
- Malignancy (T-Cell lymphoma)
Resp drive:
- CNS infection
- CNS trauma
- Drug overdose
- Guillain-Barre
- Myasthenia gravis
- kyphoscoliosis
- Flail chest
- Stroke
Organisms causing pneumonia in neonates
Neonates:
Transplacental/STROM
- Herpes simplex
- Toxoplasmosis
- Listeria
- Group B strep
Nosocomial
- Group B strep
- E coli
- Chlamydia
- Staph
Organisms causing pneumonia in children
Bacterial
- Strep pnemo
- Staph aureus
- mycoplasma
- Chlamydia
- Haemophilus
- Group A strep
Viral
- RSV
- Influenza A, B, H1N1
- Adenovirus
- Measles
VAP diagnosis
Change in colour and amount of secretions
Worsening gas exchange
+/- rising infection markers
Culture of infectious agent
Commonly pseudomonas, enterobacter cloacae & staph aureus
Empyema management
High dose IV abx for 3 weeks
Fibrinolysis:
- Small chest drain
- Urokinase 40000 IU in 40 ml 12 hourly
- clamp drain and encourage mobility
- Drain on suction
- Alteplase is an alternative
VATs surgery
Bronchiolitis
“Inflammation of the small airways of the lungs”
Infant <3 months at risk
Sx:
Antecedent URTI -> signs resp distress
Cough
Bilateral crepitations
Clinical air trapping and wheeze
Apnoea
Mx:
Oxygen
IV fluid. Restrict to 2/3 maintenance
?Ribavarin ?adrenaline nebs
CPAP
Invasive ventilation
ECMO
Mechanical ventilation in Bronchiolitis
May require high Insp pressure
PEEP 5-10 cmH2O
Low RR and increased I time
HFOV
Rarely ecmo
Asthma DDx
New dx - rule out foreign body
Mediastinal tumour
Congenital malformation
- vascular ring
- tracheal stenosis
Severe asthma exacerbation features for <5 years and >5 years
<5 years:
HR >130
Too breathless to talk or feed
RR > 50
> 5 years:
Too breathless to talk
PEFR <50%
HR >120
RR >30
Life threatening asthma signs
Confusion, exhaustion
PEFR <33%
Silent chest or poor resp effort
Cyanosis
Admission to PICU with asthma
Deteriorating PEFR
Persistent or worsening hypoxia
Hypercapnia
Falling pH
Exhaustion, poor respiration
PICU management of asthma
IV hydrocortisone 4mg/kg
IV salbutamol
(5mcg/kg for 1 hour then 1mcg/kg/hr)
IV aminophyline
5mg/kg bolus then 1mg/kg/h infusion
Magnesium
50mg/kg over 20min
Consider NIV
Intubating asthmatics
Good IV access
Fluid bolus 10ml/kg
Ketamine RSI
Cuffed tube
AVOID RAPID BAGGING
Manual decompression
