Paediatrics- Respiratory Flashcards
What is epiglottitis
Inflammation of the epiglottis and adjacent supraglottic structures, primarily due to infection. Can lead to rapid airway obstruction.
Cause of epiglottitis
caused by Haemophilius influenzae type B
(Streptococcus pneumoniae can also cause this)
Age of incidence of epiglottitis
• Typically affects children aged 2-6
Risk factors for epiglottitis
RISK FACTORS:
• Non-vaccination with Hib
• Immunocompromised
Presentation of epiglottitis
• Severe sore throat
• Odynophagia: Painful swallowing accompanied by drooling due to difficulty handling secretions
• Muffled voice/Hot potato voice: Change in voice quality due to swollen epiglottis
• Respiratory distress: Can see tripoding-> Child sitting up, leaning forward with hands on knees, neck hyperextended, bracing upper body, mouth open
• Tachycardia and Tachypnoea
• Absence of cough
• Fever
• Stridor: High-pitched inspiratory noise indicating airway obstruction
• ACUTE onset symptoms: within 12-48 hours, rapid progression
Investigations for epiglottitis
• DO NOT examine the throat in anyone with suspected Epiglottitis due to risk of airway closure
Low threshold for suspicion
• Laryngoscopy: Direct (rigid or flexible) laryngoscopy can be performed. Is diagnostic and therapeutic
• Lateral neck radiograph: Would see markedly enlarged epiglottis (thumb print sign)
• Do not lie patient down
Management of epiglottitis
• SECURE AIRWAY: Endotracheal intubation (immediate ENT and anaesthetic referral)
+
• IV Antibiotics:
• Emperic broad-spectrum antibiotics
• e.g. 3d gen cephalosporins (cefotaxime or Ceftriaxone)
• Can give vancomycin or clindamycin for penicillin allergy
Consider supplemental oxygen
Management of epiglottitis once stable and extubated
• Oral co-amoxiclav
What is bronchiectasis
Abnormal dilation of bronchi due to destruction of the elastic and muscular components of the bronchial wall
Most common cause of bronchiectasis
• Biggest cause is post-infection, and then COPD
Most common cause of infective exacerbation of bronchiectasis
Haemophilus influenzae followed by Pseudomonas aeruginosa
Pathophysiology of bronchiectasis
Chronic inflammation would lead to the development of bronchial oedema and increased mucus production (predisposes to recurrent infection)
Risk factors for bronchiectasis
• Post-infection (e.g TB)
• Immunodeficiency
• Chronic airway obstruction (COPD, asthma)
• Chronic aspiration,
• Congenital (e.g Cystic fibrosis). Most common cause in children
Presentation of bronchiectasis
• Cough: Occurs in the majority of patients (most common symptom)
• Productive cough:
◦ Daily sputum production is present in the majority of patients.
◦ Would be thick sputum and can contain pus (macropurulent).
◦ Some may experience haemoptysis (mild). Sputum production would increase during exacerbations
• Coarse Crackles, high pitched inspiratory squeaks:
• Dyspnoea: present in majority, especially on exertion
• Fever: recurrent episodes of fever due to infection
• Clubbing
• May experience pleuritic chest pain: during exacerbations
Investigations for bronchiectasis
• High resolution chest CT:
‣ Best diagnostic tool for bronchiectasis in adults.
‣ Would be able to show dilation of the bronchi with or without airway thickening
‣ Tramlines + Signet ring sign
• CXR: non specific and non-diagnostic findings. Can be normal
• FBC: can see if there is infection (WCC)
• Sputum culture and sensitivity: aids in guiding antibiotic selection. Check for haemophilius influenzae, Pseudonomas aeruginosa (more dangerous)
• CF test, serum immunoglobulins etc: tests for underlying cause of bronchiectasis
• Obstructive spirometry: FEV1 low, FVC normal
• Can perform sweat chloride test for cystic fibrosis
General management of bronchiectasis
• Exercise and improved nutrition: healthy diet and exercise recommended (exercise is a form of airway clearance), oral hydration
+ Airway clearance therapy: CHEST PHYSIOTHERAPY:
◦ included percussion, breathing and coughing strategies to remove mucus.
◦ Can give nebulised hyperosmolar agents that act as mucoactive agents (promote mucus clearance)
+ Self-management plan: increases patient’s confidence in managing their own condition
CONSIDER inhaled bronchodilator: Salbutamol
Management of bronchiectasis if pseudomonas positive
1) Antibiotic eradication therapy:
• Give oral ciprofloxacin for 2 weeks
• Then followed by IV antibiotics (beta-lactam)
+airway clearance
Secondary prevention in bronchiectasis
Routine influenza and pneumococcal vaccinations
Preventing early and severe pneumonia
Avoiding smoking and air pollution
What is bronchiolitis
Acute viral infection of the lower respiratory tract, causing bronchiolar inflammation
Most common cause of bronchiolitis
Respiratory Syncytial Virus (RSV), followed by rhinovirus
Age of incidence and time of year of bronchiolitis
• Typically affecting children <2 years old
• Usually seen in winter
Presentation of bronchiolitis
• Mild fever (<38.3)
• Dry cough
• Respiratory distress: Increased RR, wheeze, crackles (all may not be present)
• Preceded by coryzal symptoms of URTI: nasal congestion, rhinorrhoea
• Feeding difficulty
Investigations for bronchiolitis
• Pulse oximetry: ensure saturation doesn’t fall below 92%, would then require supplemental oxygen
• Immunofluorescence of nasopharyngeal secretions: diagnostic for RSV
Immediate referral for bronchiolitis if:
• Apnoea (observed or reported)
• Child looks seriously unwell
• Persistent O2 sat of <92% when breathing air
• Severe respiratory distress: grunting, marked chest recession, RR >70breaths per minute
• Central cyanosis
