Paediatric Lower Airway Issues Flashcards
Where is an aspirated foreign body most likely to end uo?
In the right main bronchus or further- this is because the right main bronchus is more vertical than the left
What are some signs of foreign body aspiration?
Decreased air entry of the affected side
Reduced chest wall expansion of the affected side
Cyanosis/ Low oxygen saturations
Note- silence on the affected side is more concerning as this can indicate a complete obstruction
Describe the difference in airway narrowing location between stridor and expiratory wheeze?
Stridor is due to airway obstruction below the larynx but in the extrathoracic upper airway, it is an inspiratory sound
Expiratory wheeze are heard when there is narrowing of the smaller airways within the thorax
What investigations should be done for foreign body aspiration?
CXR
Neck Radiograph
Bronchoscopy
Sometimes CT
What are some indirect signs of obstruction?
Consolidation distal to the obstruction
Atelectasis if complete obstruction
Air trapping can cause a mediastinal shift
What is the most common cause of acute bronchitis in children?
Influenza Type A and B Parainfluenza Adenovirus RSV Rhinovirus Coronavirus
(Most common causes are therefore viral)
What is the most common lung infection in children?
Acute Bronchiolitis
What are some bacteria that can cause acute bronchitis in children?
Bordetella pertussis (whooping cough)
Mycoplasma pneumoniae
Chlamydia pneumoniae
What are some symptoms of whooping cough?
Features of URTI- Congestion, Dysphagia
Bouts of coughing that may end with vomiting and cyanosis
Fever
What age group is whooping cough common in?
Infants but there is a second peak around 14 years of age
When are vaccines for whooping cough given?
During pregnancy
At 8, 12 and 16 weeks as it is included in the 6 in 1 vaccine
What causes the whoop of whooping cough?
The whoop occurs after breathing in when trying to inspire against a closed glottis
What antibiotic is used for pertussis?
A macrolide such as clarithromycin
Admit if less than 6 months old- may need ventilation or ECMO
What is the most common cause of acute bronchiolitis?
RSV
Acute bronchiolitis is the most common lung infection in infants
What are some of the symptoms of acute bronchiolitis?
Coryzal symptoms often precede- rhinorrhoea, sneezing, cough, congestion
What are some signs of acute bronchiolitis and associated respiratory distress?
Tachypnea Tachycardia Cyanosis IC , SC or Sternal Recession Tracheal Tug Wheeze (small intrathoracic airway obstruction) Inspiratory crackles
What are some signs that should prompt admission?
Altered mental status
Hypoxia
Difficulty feeding
Signs of respiratory distress
In which group of patients is the risk of death from acute bronchiolitis greatest?
Patients with symptomatic congenital heart defects
Other risks include- prematurity, low birth weight, non breast feeding, chronic pulmonary disease, immunodeficiency
What is included in the treatment for acute bronchiolitis?
Oxygen keeping sats >92 %
NG feeding if struggling to maintain nutritional intake
Steroids and nebulised salbutamol sometimes used
Respiratory support where needed
Fluids
How might acute bronchiolitis be prevented in at risk groups?
Ribavirin can be used which is anti-RSV retroviral medication can be used.
Prophylaxis with monthly injections of Palivizumab which is Ab against RSV can be given
At what age does acute bronchiolitis typically occur?
Children under two years of age most often between 3 and 6 months
What typically precedes acute bronchiolitis?
Coryzal prodrome- cough, congestion, rhinorrhea, low grade fever
Followed by tachypnoea, signs of respiratory distress, wheeze or crackles on auscultation
How does the cause of LRTI/Pneumonia differ between children and adults?
The cause is more likely to be viral in young children
What are some of the symptoms of pneumonia in a child?
Features of respiratory distress Poor feeding Fever (higher if bacterial) Malaise Pleuritic chest pain if near the pleural surface Productive cough Tachypnoea
How might the features of a viral and bacterial pneumonia differ?
Bacterial- start suddenly, more sever, high grade fever unlikely to have upper airway symptoms, larger rises in inflammatory markers
Viral- begin gradually, milder and less severe, more likely to have upper airway symptoms
What are some features of severe pneumonia in children?
Poor feeding
High grade fever
Lethargy/Malaise/Altered Mental Status
Failure to maintain oxygen sats above 92%
Features of respiratory distress including SC/IC/Sternal Recession, Tracheal Tug, Pallor/Cyanosis
