Paediatric respiratory conditions Flashcards
Bronchiolitis : Definition
Acute bronchiolar inflammation - most commonly secondary to RSV virus (75-80%) of cases
Bronchiolitis : Incidence
< 1 year olds } most commonly peaks 3-6 months
- Most common cause of a serious lower respiratory tract infection in < 1yr olds
- Newborns have maternal IgG which provides protection against RSV
Bronchiolitis : Cause
Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases
- May also be 2nd to bacterial infection
Bronchiolitis : Clinical symptoms
Intially : Coryzal sx (Runny nose/sneezing) + Mild fever
1) Dry cough
2) Increased breathlessness
3) Feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
Bronchiolitis : Clinical signs
Auscultation : wheezing, fine inspiratory crackles
Bronchiolitis : Criteria for immediate referral to ED
- Apnoea (observed or reported)
- Severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
- Central cyanosis
- Persistent oxygen saturation of less than 92% when breathing air.
- Child looks seriously unwell to a healthcare professional
Bronchiolitis : Management
Largely supportive management
- If low <92% O2 sats : Humidified oxygen
- NG tube if cannot be fed by mouth
- Excess airway secretions : Suction
Whooping cough : Definition
Whooping cough (pertussis) is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis
- Notifiable disease in the UK
Whooping cough : Clinical phases of disease
- Catarrhal phase ( Sx of viral upper respiratory tract infection)
- Lasts 1-2 weeks - Paroxysmal phase : coughing bouts
- Lasts 2-8 weeks - Convalescent phase : Cough subsides
- Lasts weeks to months
Whooping cough : Clinical features of Catarrhal phase
Symptoms of Upper respiratory tract infection :
- Runny nose, fever, fatigue
Whooping cough : Clinical features of Paroxysmal Phase
-
Cough
1. Increases in severity
- Paroxysmal cough - worse at night
- End with vomitting (Post tussive vomiting) or Cynosis/Apnea
- Classic ‘Inspiraotry whoop’ - forced inspiration against a closed glottis
Whooping cough : Diagnostic criteria of symptoms
*Whooping cough should be suspected if *
- a person has an acute cough that has lasted for 14 days or more without another apparent cause
** and**
- has one or more of the following features:
1. Paroxysmal cough.
1. Inspiratory whoop.
1. Post-tussive vomiting.
1. Undiagnosed apnoeic attacks in young infants.
Whooping cough : Investigation for diagnosis
- Nasal swab culture
- PCR/Serology if available
Whooping cough : Management
1. Infant < 6 months : Hospital admission
2. < 21 days since onset of cough : Oral macrolide antibiotic - Clarithromycin, Azithromycin
3 . Prophylactic Antibiotics : Household contacts
Whooping cough : Complications
- Subconjunctival haemorrhages } 2nd to high pressure coughing
- Anoxia leading to syncope & seizures
- Pneumnoa and Bronchiectasis
Whooping cough : Vaccinations
Immunisation does not guarantee lifelong protection
1. Pregnant women : 16-32 weeks - to protect newborn
2. 2 months, 3 months and four month
3. 3 years to 5 years
Acute Epiglottitis : Definition
Rapid onset of Inflamamtion and swelling of the epiglottis secondary to an infection - most commonly caused by Haemophilius influenza B
Acute Epiglottitis : Cause
Haemophilius influenza B
Acute Epiglottitis : Clinical features
Rapid onset of symptoms such as;
1. High temperature / Generally unwell
- Difficulty breathing ;
- Stridor
- Tripod position : leaned forwards and neck extended
3 . Difficulty swallowing : Drooling of Saliva
Acute Epiglottitis : Management
- O2
- IV Abx
- Avoid examining throat - risk of acute airway obstruction } Endotracheal intubation
Croup : definition
Upper respiratory tract infection which is characterised by stridor
Croup : Cause
Parainfluenza virus
Croup : Pathophysiology
- Immune response to epithelial viral infection
- ‘Laryngo-tracheitis’ : inflammation of the larynx and tachea which narrow due to swelling
Croup : Incidence
- Peak incidence 6 month - 3 years
- More common in autumn
Croup : Clinical features
- Corzyal symptoms;
1. Fever
2. Runny nose etc - Laryngeal oedema and inflammation causes
1. Stridor
2. Barking cough (worse at night)
Croup : Ix
CXR : Steeple sign
* Signified subglottic narrowing
Croup : Criteria for severe croup
- Frequent barking cough
- Stridor is audible at rest
- Sternal wall retraction at rest
- Distress/agitation/lethargy/restlessness
Croup : Criteria for admission
- Features of severe croup
- < 6 months of age
- Upper airway abnormalities : Laryngomalacia, Down’s syndrome
Croup : Management
- Oral dexamethasone (0.15mg/kg) } all patients
(can also give nebulised epinephrine if acutely unwell)
Laryngomalacia : Definition
- Congential abnormality of the larynx
- where the part of the larynx above the vocal cords (the supraglottic larynx) is structured in a way that allows it to cause partial airway obstruction.
Laryngomalacia : Pathophysiology
- Supraglottic larynx - tissue surrounding it is softer and less tone
- During inspiration - air is moving through the larynx
- Supraglottic larynx flots across the airway and partially occludes it
- Partial obstruction - generates a whistling sound
Laryngomalacia : Incidence
Infants present at 4 weeks with : Stridor
Laryngomalacia : Clinical features
- Inspiratory stridor : harsh whistling sound when breathing in, intermittent
- No associated respiratory distress
Laryngomalacia : Management
Self resolves - larynx matures and grows, increases in tone
Asthma : Mx in < 5 year old
1 . Newly diagnosed asthma : SABA
2 . SABA + an 8-week trial of paediatric MODERATE-dose inhaled corticosteroid (ICS)
After 8 weeks
* No improvement - consider alternative diagnosis
* Sx reoccur < 4 weeks } ICS low dose as maintainace
* Sx reoccur >8 weeks } Repeat 8 week trial
3 . SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
4 . Stop the LTRA and refer to an paediatric asthma specialist
