Paediatrics Flashcards
Risk factors for Bronchiolitis
Gestation age less than 37 weeks Chronological age less than 10weeks Chronic lung disease Congenital heart disease Indigenous
Bronchiolitis
Inflammation of the bronchioles usually caused Abby acute viral illness - most common RSV.
Most common lower respiratory illness in children <2yrs
Inflammation of epithelial cells of small airways leads to mucus production, inflammation, cellular necrosis. Can lead to airway obstruction and result in wheezing.
Infants who develop bronch, have a hx of mild upper respiratory tract infection, symptoms of rhinorrhea, cough, fever and decreased appetite.
Bronchiolitis characteristics
Irritating cough
Use of accessory muscles with intercostal and subcostal retractions
Wheezing
Eventually - grunting, nasal flaring, cyanosis, hypoxia and respiratory failure can occur
Fever can be present
Assessment findings and diagnosis of bronchiolitis
Acute upper respiratory illness followed by onset of respiratory distress and one or more of Cough Tachypnoea Retractions Widespread crackles or wheeze
Investigations and management of bronchiolitis
No investigations required
Supportive care only - ensure adequate oxygenation and fluid intake
Croup
Swelling of the larynx, trachea and lge bronchi due to infiltrate of WBC. Swelling results in partial airway obstruction which can result in increased WOB and the characteristic turbulent, noisy, airflow (stridor).
Obstruction- greatest at subglottic area which is the infants narrowest part of respiratory tract
Croup # 2
Upper airway obstruction - prevalent in infants 3months up to 6 years
Parainfluenza virus typical cause
Clincal manifestations of croup
Proceed after an upper respiratory tract infection
Followed by a barking cough causing various degrees of respiratory distress
Worse at night
Dyspnoea
Nasal flaring
Substernal and intercostal retractions
Management of croup
Do not upset or agitate child
Minimal handling
Keep child with carer
Mild/moderate: Dexamethasone 0.15mg/kg PO or prednisone 1mg/kg
Severe: nebulised adrenaline 0.5/kg and dexamethasone 0.6mg/kg (max 12mg) IV, IM, oral
If persists repeat adrenaline and refer to senior
Pertussis
Highly contagious bacterial infection
Characterised by paroxysmal cough
Significant cause of morbidity and mortality in children <2yrs
Epiglottitis
Cause: hot fluids, direct injury to throat and various other bacteria including streptococcus pneumoniae, strep A,B,C
Life threatening- can block airway
Clinical manifestations of Epiglottitis
Difficulty breathing, swallowing, drooling, inspiratory stridor, muffled voice.
Pts won’t have a cough
Radiology can be used to diagnose
Treatment of Epiglottitis
Protect airway - will be a difficult airway
Consider Neb adrenaline
Antibiotics
Anaphylaxis clinical manifestations
Persistent cough Wheeze Tongue swelling Stridor Horse voice Sensation Of throat swelling or tightness Dysphasia
Treatment of anaphylaxis
IM into lateral thigh of adrenaline 10mcg/kg - repeat after 5 minutes
Should be considered if swelling of the face or tongue, wheeze and urticarial rash
Foreign Body of the larynx or main bronchus
Suspect if there is a sudden, catastrophic event
Child my be coughing, choking, possibly vomiting. A complete obstruction child can rapidly deteriorate to unconsciousness and arrest
Partial obstruction
Keep child comfortable, arrange for removal in theatre
Management of complete obstruction
Open airway and directly visualise move and try to remove FB with magill forceps
Initiate 5 rescue breaths
Place child in prone with head down give 5 blows between scapula
Turn child over and give 5 thrusts to chest (same as cpr)
Recheck mouth for FB
Continue
Attempt positive pressure ventilation to remove FB
Surgical airway maybe required
Lower than main bronchus
Suspect in 6mths to 4yrs
Symptoms vary from asymptomatic to persistent wheeze, cough, fever or dyspnoea which are otherwise unexplained.
Clinical manifestations: asymmetrical chest wall movement, tracheal deviation, wheeze and decreased breath sounds
Management: place child in a comfortable position, arrange for removal in operating theatre or bronchoscopy
Fluid replacement therapy ORAL
Oral: 10ml/kg/hr of rehydration solution
Can offer diluted apple juice 1:1 if refusing ORS
If breast fed - continue - bit more Ofen
In Shocked paeds
10-20ml/kg n/saline stat
Kidneys
High urine output 1-2ml/kg/hr
Neonates and infants are unable to concentrate their urine
Glucose metabolism
Hypoglycaemia common in unwell/stressed neonates/infants
Children has an increased metabolic rate and there for increased glucose needs
Infants have small glycogen stores
Factors increasing susceptibility to respiratory illnesses in children
Age
Pre-existing medical conditions
Iiving conditions
Croup
Typically caused by Parainfluenza virus
Croup
Mild: barking cough without inspiratory stridor
Moderate: increased respiratory effort and resting stridor - still alert and active
Severe: persistent stridor, cyanosed, child is restless or apathetic, tracheal tug and intercostal recession.
A single dose of dexamthasone is required in all case of croup. Moderate requires Dex plus nebulised adrenaline. Severe May require o2
Oral rehydration
Identify any methods to help the child drink
Continue breastfeeding
Encourage oral rehydration salts (gastrolyte)
Do not give lemonade, or sports drinks
Cease any feed fortifications eg additional scoops of formula
Encourage normal diet once rehydrated
NGT rehydration
Effective for moderate dehydration.
Most children will stop vomiting once NGT feed commences
2/3 maintenance
Appropriate for most unwell children requiring hydration support
Full maintenance fluid replacement
May be appropriate for children who are not drinking adequately.
Assessment of hydration
Conscious state HR RR bP Skin colour Extremities Peripheral pulses Eyes and Fontanal Mucus membranes Skin tugur Central cap refill
