Paediatric Respiratory

Question 1

1. What is the s/s and Rx for Moderate Croup?

Answer 1

s/s: irritability, some stridor at rest, increased RR, tracheal tug and nasal flare, moderate chest wall retraction
Rx: 600mcg/kg Dexamethasone max 12mg

Question 2

2. What are the determining factors and Rx for Severe Croup?

Answer 2

Signs: increasing resp distress, increasing lethargy, decreasing stridor
Rx: Adrenaline 5mg in 5mL neb + Dexamethasone 600mcg/kg max 12mg
Repeat Adrenaline at 5/60 intervals until improvement

Question 3

3. What are indicators of Epiglottitis?

Answer 3

Drooling, absence of cough, stridor (low pitched), increased WOB, tripod/sniffing position

Question 4

4. What is the Rx for Mild/Moderate Asthma Paeds?

Answer 4

Salbutamol pMDI + spacer
≥6yrs 4-12 doses
2-5yrs 2-6doses
Repeat at 20min intervals

Question 5

5. What is the Rx for Severe Asthma Paeds?

Answer 5

Nebulised Salbutamol + 250mcg in 1mL IB
2-4yrs 2.5mg (1.25mL)
5-11yrs 2.5-5mg
Repeat salbutamol 20/60

Question 6

6. What are the signs and Rx for Critical Asthma Paeds?

Answer 6

Signs: ACS, maximal WOB, marked tachycardia, unable to talk
Salbutamol 10mg, repeat 5/60 intervals
IB 250mcg
Adrenaline 10mcg/kg IM, repeat at 5-10/60 (max 30mcg/kg)
Dexamethasone 600mcg/kg max 12mg

Question 7

7. What is the Rx for Unconscious Asthma with CO?

Answer 7

Small child 12-15 ventilations/min
Medium child 10-14 v/min
Use sufficient Vt to achieve chest rise and fall
Moderately high respiratory pressure
Allow for prolonged expiratory phase
Gentle lateral chest pressure during expiration
- If lose CO, apnoea for 30secs