Paediatric respiratory illnesses Flashcards
What are the signs and symptoms of croup?
- Seal bark cough
- Stridor – volume does not represent the severity
- Extra thoracic stridor – no stethoscope needed, in the upper airways. Intrathoracic heard on expiration when auscultating the chest.
- Hoarse voice/cry
- Fever, runny nose
- Respiratory distress – recession: intercostal, tracheal tug, sternal wall recession.
What is the name of the scoring system used to determine croup severity?
Taussig score
What is the treatment and management of croup?
- All patients with stridor must be transported
- Keep child in upright position
- Avoid upsetting the child: avoid examining nose, ears, throat, doing BM, cannulation, nebulisation unless absolutely necessary
- Steroids: Oral Dexamethasone. It is PGD drug.
What are the signs of respiratory distress in children?
- Increased RR
- Accessory muscle use
- Recessions
- Nasal flaring
- Head bobbing
- Tracheal tugging
- Cyanosis
- Abnormal noises
What are the signs and symptoms of bronchiolitis?
- Coryzal symptoms
- Respiratory distress
- Dyspnoea
- Tachypnoea
- Poor feeding
- Mild fever <39
- Apnoea
- Wheeze/Crackles
What are the signs that bronchiolitis needs to be admitted?
- <3 months
- Preexisting conditions: cystic fibrosis, downs syndrome, prematurity, congenital heart disease
- Decreased feeding by 50-75%
- Spo2 <94%
- Apnoea
- Family anxiety
What can you do to treat/manage bronchiolitis?
- Respiratory & feeding/hydration support
- Oxygen if sats <94
- IV fluids
- Nebulisers not seen to have a good effect, but nothing to stop you trying
How does Otitis media (middle ear inflammation) occur?
- Usually caused by viral infection, can be bacterial
- Child’s eustachian tubes are shorter, more horizontal and narrower. This makes it harder for them to drain.
- Can lead to perforated ear drums. Otorrhea – leaking of fluid – can indicate this.
- Retention of fluid in the middle ear can lead to recurrent ear infections
- Inflammation can spread to surrounding structures. Inflammation of the bone behind the ear – mastoiditis – is very severe and can lead to meningitis.
What are potential signs and symptoms of otitis media?
- Ear ache, fever, nausea and vomiting, lethargy, slight hearing loss
- Pulling or tugging/rubbing ear, irritable, poor feeding and restless nights, coughing and runny nose, unresponsiveness to quiet sounds, inattentiveness and loss of balance, otorrhea
- Signs and symptoms can persist for 3-5 days
What are the signs and symptoms of epiglottitis?
- Fever, sore throat, difficulty and pain when swallowing, visible epiglottis, tripoding, stridor, hoarse voice, drooling
- Protruding tongue, toxaemia
What are the signs and symptoms of whooping cough?
- Violent paroxysmal cough
- Violent cough can cause vomiting
- Can lead to hernia
- Coughing spasms can be followed by apnoea and cyanosis
- Can lead to rib fractures and straining of intercostal muscles
- Notifiable disease
What is the management of whooping cough?
Arrange hospital admission if:
- <6months of age and acutely unwell
- Significant breathing difficulties: apnoea, cyanosis, spasms
- Significant complications: seizure, pneumonia, dehydration
If hospital admission is not necessary:
- Antibiotics if onset of cough is within previous 21 days
- Macrolide antibiotic is recommended first line
Prophylaxis
- Antibiotics should be offered to close contacts of suspected or confirmed cases of whooping cough within the previous 21 days
- Groups at high risk include <2months old, pregnant women, healthcare workers, people who are regularly in contact with infants.
Patient advice:
- Rest, adequate fluid intake, paracetamol and ibuprofen
- Likely to cause cough that may last 3 months or more
How does cystic fibrosis present?
- Persistent cough/wheeze, excessive sputum, recurrent/severe pneumonia
- Chronic sinusitis and nasal polyps
- Digital clubbing
- Digestive dysfunction as the pancreatic ducts get blocked – require modified, high calorie diet. Have diminished ability to absorb fats, can lead to vitamin deficiency. May be supplemented with exogenous pancreatic enzymes.
What are the routine treatments for cystic fibrosis?
- Chest physical therapy
- High-frequency chest wall oscillation vest
- Positive expiration pressure devices
- Aerosol therapies
- Antibiotic treatments
What is the pathophysiology of croup?
- Endothelial cells disruption
- Upregulates histamine sensitivity
- Paralysis and death of cilia
- Disruption of phagocytosis
- Local necrosis
