Paediatrics - Respiratory Flashcards
What is it?
2 year old, barking cough, stridor, coryza, temperature
Croup - laryngotracheal infection
Differential - epiglottitis
What are the symptoms and treatment of bronchiolitis?
Cough, wheeze, viral symptoms, tachypnoea, tachycardia, recession, flared nostrils, poor feeding, crackles
Treatment - supportive
What are the risk factors for developing bronchiolitis?
Family smokers, chronic respirtory or cardiac conditions, born premature, immunocompromised
What is bronchiolitis?
Infection of the bronchioles - become swollen and full of mucus
Very common in children - 1/3 have it before a year of age
What is the most common causative pathogen of bronchiolitis?
RSV (respiratory synctial virus) - 80% of time
What is it?
Child comes in, hyperextended, drooling, increased cappilary refill, stridor, muffled voice
How would you treat this?
Epiglottitis
Be very careful with child, do not agitate!
IV antibiotics
What is the main pathogen causing epiglotitis?
Hib (haemophilis influenza type B, aerobic diplococci) - decreased since vaccine
What are the treatment steps of chronic childhood asthma?
- Environment
- SABA and ICS
- Monteleukast
- LABA
- Increase ICS
- Oral steroids
How do you treat croup?
Self-limiting
Steroids - prednisilone, dexamethasone, nebulised budesonide
Occasionally o2, nebulised adrenaline and intubation
What are signs of CF?
Neonate - meconium ileus
Older - recurrent chest infections, recurrent wheeze, failure to thrive
How would you treat CF?
O2, antibiotics, steroids,
Blocking Na reabsorption - amiloride
Stimulate Cl secretion - adenoside
transplant
What type of inheritance is CF? How common is it?
autosomal recessive
1/25 in general public
What is the chronic lung disease of prematurity?
needing o2 at 36 weeks or 28 days after birth, decreased lung volume diffusion, decreased alveolar SA defect, increased mortality, recurrent admission
What are some respiratory complications of being born prematurely?
lack of surfactant = respiratory distress syndrome surfactant decreased surface tension to prevent alveolar collapse
alveoli absent at 24 weeks
lung damage is worsened by O2, sepsis, ventilation
Name 3 antibiotics used in pneumonia
amoxicillin
cefurotxime
cefatamine
beta-lactam
How would you manage epiglottitis?
call paediatrician, anaesthetics and ENT surgeon
transfer to ITU - intubate
bloods - culture
IV antibiotics e.g. cefuroxime
Name some symptoms of epiglottitis
rapid onset - hours no coryza, absent/slight cough can't drink drool saliva > 38.5 temp muffled voice soft stridor appears toxic
What is respiratory distress syndrome?
lack of surfactant from Type 2 penumocytes results in increased surface tension and alveolar collapse
When is it asthma and when is it viral induced wheeze?
VIW <5
Asthma >5
Name 2 bronchodilators
Salbutamol and ipratropium
Name 2 steroids to treat acute asthma
oral prednisione
IV hydrocortisone
What alternative medicines would you use to treat acute asthma?
magnesium, aminophylline, salbutamol
What would you see on a blood gas in Type 1 respiratory failure?
Name 3 causes
low O2 and normal/low CO2
damage to lung tissue (acute hypoxaemic) - pulmonary oedema, pneumonia, ARDS
What would you see on a blood gas in Type 2 respiratory failure?
Name 3 causes
low O2 and high CO2
failure to ventilate - COPD, GBS, Duchenne’s, opiods, chronic bronchitis
What are the symptoms of hypercapnia?
CRAB - confusion, reduced consiousness, asterixis, bounding pulse
What is the definition of stridor?
harsh vibrating noise when breathing, caused by obstruction of windpipe or larynx
What is the definition of wheeze?
Breathe with a whistling or rattling sound in chest as result of obstruction in air passages
What are the main causes of wheeze?
Asthma, bronchiolitis, viral induced wheeze, pnuemonia
What are the main causes of stridor?
Croup, epiglottitis, bacterial tracheitis, diptheria, inhaled foreign body, anaphylaxis
What are the signs of respiratory distress?
cyanosis, tracheal tug, subcostal/intercostal recession, hypoxia, tachycardia, wheeze, stridor, head bobbing
What is palivizumab?
monoclonal antibody against RSV - vaccine given once a month during winter to CF, premature, chronic lung disease, immunodeficient
What causes pertussis?
upper respiratory tract infection - bordetella pertussis - gram negative cocobacilli
What causes CF?
autosomal recessive gene that alters the cystic fibrosis transmembrane conductance regulatory gene on chromosome 7 - codes for chlorine channels
What does ground glass appearance of lungs on a CXR mean?
surfactant deficiency - especially common
Surfactant production begins between 24-28 weeks
What is bronchiectasis?
dilation of bronchioles and poor mucociliary clearance
What are the commonest causative organisms of pneumonia in children?
steptococcus pneumonia
haemophilis influenza
What is an empyema and how would you trest for it?
it is a pleural effusion with pus
- pH <7.2, glucose < 3.3
What are the levels of acute asthma attack severity and some symptoms?
Moderate - o2>92%, RR <30 children >5, can talk normally
Acute severe - o2 <92%, PEF 33-50%, HR >140 in <5s, >125 >5s
Life-threatening - exhaustion, hypotension, cyanosis, silent chest, confusion, PEF <33%, o2 <92%
How would you manage an acute asthma attack?
02 salbutamol, terbutaline ipratropium bromide steroids - prednisilone, hydrocortisone antibiotics LTRA nebulised magnesium sulphate IV salbutamol, aminophylline, magnesium sulphate
