Paediatrics Respiratory Flashcards
What is bronchiolitis?
Inflammation and infection in the bronchioles (small airways of the lungs)
What is bronchiolitis usually caused by?
Virus - respiratory syncytial virus is the most common cause
When does bronchiolitis typically occur?
Children under 1 year (most common in children under 6 months)
Rarely its diagnosed in children up to 2 years of age, particularly in ex-premature babies with chronic lung disease
What happens when a virus affects the airways of adults?
Swelling and mucus are proportionally so small that it has little noticable effect on breathing
How does bronchiolitis present?
Coryzal symptoms. These are the typical symptoms of a viral upper respiratory tract infection: running or snotty nose, sneezing, mucus in throat and watery eyes.
Signs of respiratory distress
Dyspnoea (heavy laboured breathing)
Tachypnoea (fast breathing)
Poor feeding
Mild fever (under 39ºC)
Apnoeas (episodes where the child stops breathing)
Wheeze and crackles on auscultation
What are coryzal symptoms?
What are the signs of respiratory distress in paediatrics?
Raised respiratory rate
Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis (due to low oxygen saturation)
Abnormal airway noises
What abnormal airway noises can be heard during bronchiolitis?
Wheezing = whistling sound caused by narrowed airways, typically heard during expiration
Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure
Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup
What is the course of respiratory syncytial virus?
- Starts as URTI with coryzal symptoms
- 1-2 days after onset of coryzal symptoms chest symptoms develop
- Symptoms are worst on day 3 or 4
- Symptoms usually last 7 to 10 day
- Full recover within 2-3 weeks
What can result from bronchiolitis in infancy?
Viral induced wheeze during childhood
Why may a child be admitted for bronchiolitis?
- Aged under 3 months or any pre-existing condition such as prematurity, Downs syndrome or cystic fibrosis
- 50 – 75% or less of their normal intake of milk
- Clinical dehydration
- Respiratory rate above 70
- Oxygen saturations below 92%
- Moderate to severe respiratory distress, such as deep recessions or head bobbing
- Apnoeas
- Parents not confident in their ability to manage at home or difficulty accessing medical help from home
What is the management of bronchiolitis?
Supportive management:
- Ensuring adequate intake. This could be orally, via NG tube or IV fluids depending on the severity. It is important to avoid overfeeding as a full stomach will restrict breathing.
- Saline nasal drops and nasal suctioning can help clear nasal secretions
- Supplementary oxygen if the oxygen saturations remain below 92%
- Ventilatory support if required
What is there limited evidence for treating bronchiolitis with?
Nebulised saline
Bronchodilators
Steroids
Antibiotics
What are the ventilatory support options for brochiolitis treatment?
High-flow humidified oxygen via tight nasal cannula (i.e. “Airvo” or “Optiflow”). It adds “positive end-expiratory pressure” (PEEP) to maintain the airway at the end of expiration.
Continuous positive airway pressure (CPAP). Similar way to Airvo or Optiflow, but can deliver much higher and more controlled pressures.
Intubation and ventilation. This involves inserting an endotracheal tube into the trachea to fully control ventilation.
How can ventilation be assessed in paediatric patients?
Capillary blood gases are useful in severe respiratory distress
Rising pCO2
Falling pH (respiratory acidosis = type 2 respiratory failure)
What can be given as prophylaxis against bronchiolitis caused by RSV? Who is it given to?
Palivizumab (monoclonal antibody) given as a monthly injection as prevention against bronchiolitis
Extremely-premature and those with congenital heart disease
Is palivizumab a true vaccine?
No as it does not stimulat the infant’s immune system - instead provides passive protection by circulating the body until the virus is encountered, at which point it works as an antibody against the virus (levels of circulating antibodies decrease over time which is why a monthly injection is required)
What is a viral induced wheeze?
Acute wheezy illness caused by a viral infection (due to inflammation, oedema, swelling of the walls of the airways, contraction of smooth muscles of the airways)
What typically causes a viral induced wheeze in children?
RSV or rhinovirus
What law states that flow rate is proportional to the radius of the tube to the power 4?
Poiseuille’s law
How can a viral induced wheeze be distinguished from asthma?
Not definitive but:
- Presenting before 3 years of age
- No atopic history
- Only occurs during viral infections
How does a viral induced wheeze present?
Shortness of breath
Signs of respiratory distress
Expiratory wheeze throughout the chest
(neither viral induced wheeze or asthma cause a focal wheeze - if you hear this then be very cautious and investigate further for foreign body or tumour)
What is the management of viral induced wheeze?
Same as acute asthma in children
What is an acute exacerbation of asthma characterised by?
Rapid deterioration in the symptoms of asthma (could br triggered by any of the normal triggers of asthma e.g. infection, exercise or cold weather)
How does an acute exacerbation of asthma present?
Progressively worsening shortness of breath
Signs of respiratory distress
Fast respiratory rate (tachypnoea)
Expiratory wheeze on auscultation heard throughout the chest
The chest can sound “tight” on auscultation, with reduced air entry
What are the signs of moderate, severe and life-theatening asthma?
What are the components of management of acute asthma / viral induced wheeze?
Supplementary oxygen if required (i.e. oxygen saturations less than 94% or working hard)
Bronchodilators (e.g. salbutamol, ipratropium and magnesium sulphate)
Steroids to reduce airway inflammation: prednisone (orally) or hydrocortisone (intravenous)
Antibiotics only if a bacterial cause is suspected (e.g. amoxicillin or erythromycin)
How can bronchodilators be stepped up in acute asthma?
Inhaled or nebulised salbutamol (a beta-2 agonist)
Inhaled or nebulised ipratropium bromide (an anti-muscarinic)
IV magnesium sulphate
IV aminophylline
How can mild cases of acute asthma be managed?
As an outpatient with regular salbutamol inhalers via a spacer (e.g. 4-6 puffs every 4 hours)
What is the stepwise approach for moderate to severe cases?
Salbutamol inhalers via a spacer device: starting with 10 puffs every 2 hours
Nebulisers with salbutamol / ipratropium bromide
Oral prednisone (e.g. 1mg per kg of body weight once a day for 3 days)
IV hydrocortisone
IV magnesium sulphate
IV salbutamol
IV aminophylline
If all the steps of acute asthma management have been covered, what is the next step?
Anaesthetist and ICU need calling (intubation and ventilation)
How to review a patient with acute asthma?
- Review prior to next dose of bronchodilator
- Look for evidence of cyanosis (central or peripheral), tracheal tug, subcostal recessions, hypoxia, tachypnoea or wheeze on auscultation
- If they look well then consider stepping down the number and frequency of intervention
- Step down inhaled salbutamol: 10 puffs 2 hourly, 10 puffs 4 hourly, 6 puffs 4 hourly, then 4 puffs 6 hourly
What else may need monitoring when on high doses of salbutamol?
Serum potassium (causes potassium to be absorbed from the blood into the cells)
Salbutamol can cause tachycardia and a tremor
What to advise on discharge of a patient with acute asthma?
- Finish course of steriods (typically 3 days in total)
- Provide safety-net information about when to seek help
- Provide individualised written asthma action plan
What is asthma?
Chronic inflammatory airway disease
Smooth muscle airways is hypersensitive and responds to stimuli by constricting and causing airway obstruction
Name some other atopic conditions?
Asthma
Eczema
Hay fever
Food allergies
(run in families so ask FH)
What presentation typically suggests asthma?
- Episodic (intermittent exacerbations)
- Diurnal variaion (worse at night)
- Dry cough with wheeze and SoB
- Typical triggers
- FH of atopy
- Widespread polyphonic wheeze
- Improves with bronchodilators
What respiratory symptoms suggest a diagnosis other than asthma?
Wheeze only related to coughs and colds (viral induced wheeze)
Productive cough
No response to treatment
Unilateral wheeze suggesting focal lesion or inhaled foreign body
Name some typical triggers for asthma?
- Dust
- Animals
- Cold air
- Exercise
- Smoke
- Food allergens (e.g. peanuts, shellfish or eggs)
How is asthma diagnosed?
No gold standard
Clinical on history and examination
Usually after 2 to 3 years old
If low possibility then refer to specialist for diagnosis
If high possibility then trial of treatment with diagnosis if symptoms improve
What tests can help with diagnosis of asthma?
Spirometry with reversibility testing (in children aged over 5)
Direct bronchial challenge test with histamine or methacholine
Fractional exhaled nitric oxide (FeNO)
Peak flow variability (measured several times a day for 2 to 4 weeks)
What are the principles for the stepwise ladder for asthma?
Start at the most appropriate step for severity of symptoms
Review regularly
Step up and down ladder based on symptoms
Aim for no symptoms or exacerbations on the lowest dose
Always check inhaler technique and adherence at each review
What is the medical therapy for asthma in under 5?
- Start SABA (e.g. salbutamol)
- Add low dose corticosteroid inhaler or leukotriene antagonist (i.e. oral montelukast)
- Try both of the above
- Refer to specialist
What is the medical treatment for asthma in patients 5-12?
- SABA
- Regular low dose cortiosteroid inhaler
- Add a LABA (e.g. salmeterol)
- Titrate up the corticosteriod inhaler to a medium dose
- Add oral leukotriene receptor antagonist e.g. montelukast or oral theophylline
- Increase the dose of the inhaled corticosteroid to a high dose
- Referral to a specialist (may require daily oral steroids)
What is the medical treatment for asthma in patients over 12?
- SABA as required
- Regular low dose corticosteroid inhaler
- LABA (continue only if good response)
- Titrate up corticosteroid dose to medium
- Trial leukotriene receptor antagonist / oral theophylline / LAMA (i.e. tiotropium)
- Titrate up inhaled corticosteroid to high
- Combine options from step 5
- Refer to specialist
- Add oral steroids at the lowest dose possible to achieve good control
Can inhaled steroids slow growth? What is the argument for them?
Yes up to 1cm when used longer than 12 months
It prevents asthma attacks which could lead to high doses of oral steroids, poorly controlled asthma can lead to a more significant impact on growth and development.
Child has regular reviews to ensure they’re on minimum dose
What is a complication of poor inhaler technique?
Medication in the mouth - reduces effectiveness and causes complications such as oral thrush
How to used a metered dose inhaler?
- Remove cap
- Shake inhaler
- Sit / stand up straight
- Lift the chin
- Fully exhale
- Make a tight seal
- Take a steady breath in whilst pressing
- Hold breath for 10 seconds
- Wait 30 seconds before further dose
- Rinse mouth after using steroid inhaler
How to use a metered dosed inhaler with a spacer?
- Assemble spacer
- Shake
- Attach inhaler to correct end
- Sit / stand straight
- Lift chin slightly
- Make a seal around mouthpiece
- Spray dose into spacer
- Take steady breaths in and out until mist is inhaled
Clean once a month - avoid scrubbing inside and allow them to air dry to avoid static (can interact with mist and prevent inhalation)
What is pneumonia caused by?
Bacteria
Virus
Atypical bacteria e.g. mycoplasma
How does pneumonia present in children?
Cough (wet and productive)
High fever (>38.5)
Tachypnoea
Tachycardia
Increased work of breathing
Lethargy
Delerium (acute confusion associated with infection)
What additional signs for pneumonia in children?
Hypoxia (low oxygen)
Hypotension (shock)
Fever
Confusion
What are the chest signs of pneumonia in children?
Bronchial breath sounds: harsh breath sounds equally loud on inspiration and expiration
Focal coarse crackles: caused by air passing through sputum similar to using a straw to blow into a drink
Dullness to percussion due to tissue collapse / consolidation
What are the bacterial causes of pneumonia in children?
Streptococcus pneumonia
Group A strep (e.g. Streptococcus pyogenes)
Group B strep occurs in pre-vaccinated infants, often contracted during birth as it often colonises the vagina.
Staphylococcus aureus. This causes typical chest xray findings of pneumatocoeles (round air filled cavities) and consolidations in multiple lobes.
Haemophilus influenza particularly affects pre-vaccinated or unvaccinated children.
Mycoplasma pneumonia, an atypical bacteria with extra-pulmonary manifestations (e.g. erythema multiforme).
What are the viral causes of pneumonia in children?
Respiratory syncytial virus is the most common
Parainfluenza virus
Influenza virus
What are the investigations for pneumonia in children?
Chest X-ray (not routinely required)
Sputum cultures / throat swabs for bacterial culture / viral PCR to find causative organism and guide treatment
Blood cultures for sepsis
Capillary blood gas analysis to monitor respiratory / metabolic acidosis and the blood lactate level in unwell patients
What is the management of pneumonia in children?
Antibiotics according to local guidelines
Amoxicillin is often first line
Macrolide (erythromycin, clarithromycin or azithromycin) will cover atypical pneumonia or as monotherapy in patients with a penicillin allergy
IV abx if sepsis or problem with intestinal absorption
Oxygen to keep sats above 92%
What should be looked for in a child with recurrent LRTIs?
Reflux
Aspiration
Neurological disease
Heart disease
Asthma
CF
Primary ciliary dyskinesia
Immune deficiency
What tests can be done for children with recurrent LRTI?
Full blood count for WBCs
Chest xray - any structural abnormality in the chest or scarring from the infections.
Serum immunoglobulins - selective antibody deficiency.
Test immunoglobulin G to previous vaccines (i.e. pneumococcus and haemophilus). Some patients are unable to convert IgM to IgG, and therefore cannot form long term immunity to that bug. This is called an immunoglobulin class-switch recombination deficiency.
Sweat test to check for cystic fibrosis.
HIV test, especially if mum’s status is unknown or positive.
What is croup?
Acute infective respiratory disease of children aged 6 months to 2 years
URTI causing oedema in the larynx
What are the causes of croup?
Parainfluenza (most common)
Influenza
Adenovirus
Respiratory syncytial virus
What caused croup previously
Diphtheria leading to epiglottitis with a high mortality - vaccination means that this is rare in developed countries
How does croup present?
Increased work of breathing
Barking cough in episodes
Hoarse voice
Stridor
Low grade fever
What is the management of croup?
Most managed at home with fluids and rest
Sit upright during attacks
Measures to avoid spread e.g. hand washing and staying off school
Stepwise options in severe croup:
- Oral dexamethasone (150mcg/kg - can be repeated after 12 hours, prednisolone is an alternative e.g. at GPs)
- Oxygen
- Nebulised budesonide
- Nebulised adrenaline
- Intubation and ventilation
What is epiglottitis?
Inflammation and swelling of the epiglottis caused by infection, typically with haemophilus influenza type B
Is epiglottitis an emergency?
Yes but its rare now due to routine vaccination against haemophilus influenza type B
How does epiglottitis present?
Similar way to croup by with more rapid onset
- Fever
- Sore throat and stridor
- Sitting forward and drooling
- Tripod position
- Muffled voice
- Scared and quiet child
What are the investigation of epiglottitis?
If acutely unwell then treat before
Lateral xray of the neck shows a characteristic thumbprint sign caused by the oedematous and swollen epiglottis - also useful to exclude a foreign body
What is the management of epiglottitis?
Do not distress patient
Alert most senior paediatrician and anaesthetist available
Intubation should be prepared for incase of sudden upper airway closure
Tracheostomy may be required in ICU
Once airway is secured then: IV abx (ceftriaxone) or steroids (dexamethasone)
What is a complication of epiglottitis?
Epiglottic abscess which is a collection of pus around the epiglottis also threatening the airwary making it a life threatening emergency - treatment similar to epiglottitis
What is laryngomalacia?
Part of larynx above vocal cords (supraglottic larynx) is structured in a way that allows it to cause partial airway obstruction causing chronic stridor on inhalation when the larynx flops across the airway as the infant breathes in
What is stridor?
Harsh whistling sound caused by air being forced through an obstruction of the upper airway
What are the structural changes in laryngomalacia?
Shortened aryepiglottic folds (run between the epiglottis and the arytenoid cartilages - they constrict the opening of the airway to prevent food or fluids entering the largyn and traches)
How does the epiglottis change in laryngomalacia?
Ayrepiglottic folds are shortened which pulls on the epiglottis and changes its shape to a characteristic “omega” shape
How is the tissue around the supraglottic larynx different in laryngomalacia? When is it worse?
Softer and less tone meaning it can flop across the airway
Worse on inspiration - causing whistling sound
When does laryngomalacia present?
Infants, peaking at 6 months with inspiratory stridor - intermittent and worse when feeding, upset on back, during URTIs.
What is the management of laryngomalacia?
Problem resolves as larynx matures and grows - better able to support itself - usually no interventions and the child is left to grow out of the condition.
Rarely tracheostomy may be necessary, surgery is also an option.
What is whooping cough?
URTI caused by bordetella pertussis (a gram negative bacteria) (called whooping due to severe sucking in of air in between coughs)
Who is vaccinated against pertussis?
Children and pregnant women (less effective after a fews years after each dose)
How does pertussis present?
Mild coryzal symptoms
Low grade fever
Coughing fits a week later (paroxysmal coughing)
What can be a result of harsh coughing?
Vomit
Faint
Pneumothorax
(not all patients will “whoop” and infants with pertussis may present with apnoeas rather than a cough)
How is whooping cough diagnosed?
Nasopharyngeal or nasal swab with PCR testing or bacterial culture can confirm the diagnosis within 2 to 3 weeks of the onset of symptoms
What can be tested for if whooping cough has been present for more than 2 weeks?
Anti-pertussis toxin immunoglobulin G - tested for in oral fluid of children aged 5 to 16 and blood of those aged over 17
Is whooping cough a notifiable disease?
Yes (so inform public health)
What is the management of whooping cough?
Supportive care
Vulnerable / acutely unwell / those under 6 months and patients with apnoeas, cyanosis or patients with severe coughing fits may need to be admitted
How to avoid spread in whooping cough?
Avoid contact with vulnerable people
Disposing of tissues
Careful hand hygiene
What is the antibiotic choice in whooping cough?
Macrolide antibiotics such as azithromycin, erythromycin and clarithromycin can be beneficial in the early stages (within 21 days)
Co-trimazole is an alternative
What are vulnerable people (pregnant, unvaccinated infants or HCW) given who have contact with patients with whooping cough?
Prophylactic abx
How long do symptoms of whooping cough last?
Resolve in 8 weeks
Can be several months - hence “100 day cough”
What is a complication of whooping cough?
Bronchiectasis
What is chronic lung disease of prematurity?
Occurs in premature babies (before 28 weeks gestation) in those that suffer with respiratory distress syndrome requiring oxygen or intubation and ventilation
What is chronic lung disease of prematurity also known as?
Bronchopulmonary dysplasia
How is CLDP diagnosed?
Chest X-ray and when the infant requires oxygen therapy after they reach 36 weeks gestational age
What are the features of CLDP?
- Low oxygen sats
- Poor feeding
- Crackles and wheezes on chest auscultation
- Increased susceptibility to infection
How can CLDP be prevented?
Giving corticosteroids e.g. betamethasone to mothers that show signs of premature labour at less than 36 weeks gestation
How can CLDP be prevented once neonate is born?
Using CPAP rather than intubation and ventilation where possible
Using caffeine to stimulate respiratory effort
Not over-oxygenating with supplementary oxygen
Whats the management of chronic lung disease of prematurity?
Sleep study assesses oxygen sats during sleep - supporting diagnosis and guiding management
Babies discharged on a low dose of oxygen to continue at home e.g. 0.01 litres per minute via nasal cannula - weaned off over first year of life
What do babies with CLDP require protection from?
Respiratory syncytial virus to reduce risk and severity of bronchiolitis involving monthly injections of a monoclonal antibody against the virus called palivizumab - expensive at around £500 per injection so reserved for babies meeting certain criteria
What is cystic fibrosis?
Autosomal recessive condition of mucus glands caused by a mutation in cystic fibrosis transmembrane conductance regulatory gene on chromosome 7
What is the most common variant of the mutation on chromosome 7?
Delta-F508
What does the gene involved in CF code for ?
Chloride channel
How many carriers are there of CF?
1 in 25 (1 in 2500 have CF)
What are the 3 consequences of CF?
Thick pancreatic and biliary secretions causing the ducts to become blocked and a lack of digestive enzymes such as pancreatic lipase in the digestive tract
Low volume thick airway secretions which reduce airway clearance resulting in bacterial colonisation and susceptibility to airway infections
Congenital bilateral absence of the vas deferens in men - male infertility (generally have healthy sperm)
When is CF screened for?
At birth with newborn bloodspot test
What is the first sign of CF?
Meconium ileus - first stool baby passes is called meconium and should be within first 24 hours of birth - in CF the meconium is thick and sticky causing it to get stuck and obstruct bowel causing abdo distention and vomiting
How does CF present later in life?
Recurrent LRTIs
Failure to thrive
Pancreatitis
What are the symptoms of CF?
- Chronic cough
- Thick sputum production
- Recurrent respiratory tract infections
- Loose greasy stools (steatorrhoea) due to lack of lipase
- Abdo pain and bloating
- Parent may state that child tastes salty when they kiss them
- Failure to thrive (poor weight and height)
What are the signs of CF?
- Low weight / height on growth charts
- Nasal polyps
- Finger clubbing
- Crackles and wheezes on auscultation
- Abdo distention
What are the causes of clubbing in children?
- Hereditary clubbing
- Cyanotic heart disease
- Infective endocarditis
- CF
- TB
- Inflammatory bowel disease
- Liver cirrhosis
What are the three ways to diagnose CF?
Newborn blood spot testing (picks up most cases)
Sweat test is the gold standard for diagnosis
Genetic testing for CFTR gene can be performed during pregnancy by amniocentesis or chorionic villous sampling or as a blood test after birth
How is the sweat test for CF performed?
- Patch of skin is chosen for the test (typically on arm or leg)
- Pilocarpine is applied to the skin on this patch
- Electrodes placed either side and a current passed
- Causes skin to sweat
- Sweat is absorbed with lab issued gauze or filter paper and sent to the lab for testing for chloride concentration
What is the diagnostic chloride concentration for cystic fibrosis ?
More than 60 mmol / L
What are some common colonisers in CF?
Staphylococcus aureus
Haemophilus influenza
Klebsiella pneumoniae
Escherichia coli
Burkhodheria cepacia
Pseudomonas aeruginosa
What prophylaxis do patients with CF take?
Flucloxacillin against staph aureus infection
Pseudomonas is a particularly troublesome coloniser which is hard to treat and worsens the prognosis of patients with CF
Why are there no more social events for children with CF?
Due to risk of spreading pseudomonas
How is pseudomonas colonisation treated?
Long term nebulised antibiotics such as tobramycin, oral ciprofloxacin is also used
What is the management of cystic fibrosis?
Chest physio several times a day to clear mucus and reduce risk of infection
Exercise for respiratory function and clear sputum
High calorie diet for malabsorption
CREON tablets for pancreatic insufficiency (replaces missing lipase)
Prophylactic flucloxacillin to reduce risk of bacterial infections (especially staph aureas)
Treat chest infections when they occur
Bronchodilators e.g. salbutamol for bronchoconstriction
Nebulised DNase (dornase alfa) - an enzyme which can break down DNA material in respiratory secretions, making them less viscous and easier to clear
Nebulised hypertonic saline
Vaccinations including pneumococcal, influenza and varicella
What are the further treatment options in cystic fibrosis?
Liver transplantation for end stage respiratory failure
Liver transplant in liver failure
Fertility treatment involving testicular sperm extraction for infertile males
Genetic counselling
How often are patients with CF followed up?
Every 6 months
What are patients with cystic fibrosis monitored for?
Colonisation of pseudomonas
Diabetes
Osteoporosis
Vitamin D deficiency
Liver failure
What are the complications of cystic fibrosis? What is the life expectancy?
Pancreatic insufficiency (90% of patients)
Cystic fibrosis-related diabetes (50% of patients)
Liver disease (30% of patients)
Inferfility in males due to absent vas deferens
Life expectancy = 47 years
What is primary ciliary dyskinesia (PCD) also known as?
Kartagner’s syndrome
What is the mode of inheritance for PCD?
Autosomal recessive condition
Where is PCD more common?
Populations where there is consanguinity meaning the parents are related to one another (increased risk of child having two copies of the same recessive genetic mutation)
What is the result of PCD?
Dysfunction of the motile cilia around the body - especially respiratory tract
Causes a build up of mucus in the lungs providing a site for infection
Cilia in fallopian tube and flagella of sperm is affected causing reduced or absent fertility
What is the link to primary ciliary dyskinesia?
To situs inversus
How does PCD present?
Frequent and recurrent chronic chest infections
Poor growth
Bronchiectasis
(like CF)
What is Kartagner’s triad?
Three key features of PCD:
- Paranasal sinusitis
- Bronchiectasis
- Situs Inversus
(not all patients will have these)
What is situs inversus?
The internal (visceral) organs are mirrored inside the body
Heart and stomach on the right with the liver on the left (dextrocardia is where only the heart is reversed)
What heart problem may be associated with situs inversus?
Transposition of the great arteries
How is PCD diagnosed?
Sample of ciliated epithelium from nasal brushing or bronchoscopy and examination of the cilia
Recurrent respiratory tract infections
Look for history of consanguinity in the patents
CXR for situs inversus
Semen analysis for male infertility
What is the management of PCD?
Similar to cystic fibrosis and bronchiectasis with daily physio, high calorie diet and abx
What conditions put children in extremely vulnerable category?
- Solid organ transplant recipients
- Certain cancers
- Respiratory conditions e.g. CF / asthma
- Immunodeficiency disorders e.g. SCID
- Long term immunosuppressive therapies
What is the history of a covid patient?
Fever
Dry cough
Headache
Sore throat
Myalgia
SoB
Diarrhoea
N+V
What is found on examination of a covid patient?
Low O2 sats
Increased RR
Intercostal regression
Tracheal tug
Tachycardia
What are the differentials for COVID-19?
URTI (tonsillitis, otitis media)
LRTI (pneumonia)
Exacerbation of asthma
Viral induced wheeze
Allergy
UTI
Gastroenteritis
What are the investigations for COVID-19?
CXR (bilateral infiltrates)
CRP and ESR elevated
FBC (lymphopenia, neutrophilia)
Liver enzymes (elevated)
Lactate dehydrogenase (elevated)
D-dimer (raised)
What is the treatment of COVID-19?
- Oxygen supplementation (low flow - high flow - CPAP - BiPAP - Mechanical ventilation)
- Fluid management
- Abx (if secondary bacterial infection / sepsis)
What is the complication of COVID-19?
ARDS
