Paediatric respiratory Flashcards
DDx of respiratory distress
Bronchiolitis
Pneumonia
Viral induced wheeze
Asthma
Foreign body inhalation
Epiglottitis
Croup
Tonsillitis/pharyngitis
TB
Laryngomalacia
What is bronchiolitis caused by
RSV in most case
Bronchiolitis presentation
up to 2 yrs of age usually
coryzal prodrome last 1-3 days
peristent cough
tachypnoea
chest recession
wheeze / crackles on auscultation
Bronchiolitis treatment
Self resolve
If moderate - admit for oxygen
Croup presentation
SEAL LIKE BARKING COUGH
fever
stridor
6 months - 6 yrs age
Croup treatment
Steroid - dexamethasone single dose
What causes pertussis
bordatella pertussis
notifiable disease!
Pertussis presentation
cough - paroxysms
whoops
post cough vomiting
may last 2-3 months
Petussis tx
Clarithromycin 5-7 days
Off skl for 21 days following onset or 48 hrs post abx
Abx prophylaxis and vaccine for close relatives
Acute epiglottis symptoms
drooling
fever
muffled voice
tripod stance
Acute epiglottis treatment
SEVERE AIRWAY OBSTRUCTION - EMERGENCY - DON’T EXAMINE
ENT anaesthetist
Secure airway
Adrenaline
Nasoendoscopy
Intubation
IV abx
IV steroid
What is cystic fibrosis and what can it lead to
autosomal recessive disease mutation in CFTR gene causing build up of mucus in multi0ple organs
predisposes to infection
poor digestion
infertility
diabetes
osteoporosis
pulmonary hypertension
Cystic fibrosis presentation
Neonatal blood spot
Meconium ileus
Recurrent chest infections
Family history
Cystic fibrosis investigations
Sweat test
Lung function test
Genetic testing
REFER TO CF CENTRE
Cystic fibrosis treatment
Chest physio
Prophylactic abx
Mucolytics
Pancreatic enzymes
Why does CHRONIC LUNG DISEASE OF
PREMATURITY (BRONCHOPULMONARY
DYSPLASIA) cause resp distress
Surfactant produced from 23 weeks
Makes lungs less ‘stiff’
Without it, alveoli collapse = resp distress
Chronic lung disease of prematurity - bronchopulmonary dysplasia treatment
Corticosteroids promote production
Surfactant therapy given +/- mechanical ventilation
However prolonged mechanical ventilation- causes alveolar injury
Many improve by 2 years
Tx: CPAP + steroids + + diuretics + RSV monoclonal antibody injections
Prognosis: increased frequency and severity of chest infections, reduced lung function
Laryngomalacia presentation
in first 2 weeks neonate
- floppy larynx
- stridor
- inward collapse of airway during inspiration
- worse when feeding, crying or sleeping (OSA)
- harsh cough
- feeding difficulties
- sleeping difficulties
Laryngomalacia treatment
ENT or MLB referral
OSA presentation
snoring
mouth breathing
daytime sleepiness
OSA investigations and treatment
Sleep study
Tx
- CPAP
- weightloss
- ent referral
Signs of foreign body inhalation and tx
persistent wheeze
cough
resp distress
Tx - CXR and refer to ENT for MLB
