Paeds Airway Disease Flashcards
Ddx stridor (min 5)
FB ingestion
Croup
Epiglotittis
Bacterial tracheitis
Trauma - direct blow to neck
Congenital - tracheomalacia
Peritonsillar abscess - quincy
Ddx wheeze
Asthma\ VIW
Inhaled Foreign Body
Bacterial bronchitis
Gord
Osa
Anaphylaxis
CCF
Pneumonia
Croup
Risk fx severe croup
Previous admission severe croup
Pre existing narrow upper airway
Young age
Croup - age group, causes
6 m.o 6 y.o
Parainfluenza, RSV, Influenza
Croup - Mild -moderate
Mild - barking cough, stridor when upset, minimal WOB.
Mod- stridor at rest, tachypnoea, mod WOB
Rx: pred 1mg/kg or Dex 0.15mg/kg
Dc 30mins post steroid ＆ stridor free at rest
Croup - Severe
Irritable, lethargy, stridor at rest, marked WOB, chest wall retraction
Rx: Dex 0.6mg/kg, Neb Adrenaline 0.5ml/kg max 5mls 1:1000
Obs 4 hrs post neb adrenaline, DC stridor free at rest
Severe asthma treatment
O2
Salbutamol burst
Ipatropium burst
Aminophylline - loading dose 10mg/kg over 60mins
MgSO4 0.15mmol/kg over 20mins
Po Prednisone 2mg/kg or IV Methylpred 1mg/kg
Critical Asthma treatment
Continous salbutamol nebs
O2
Ipatropium 250mcg Q 20mins
Iv Methylpred 1mg/kg q6hrly
MgSO4 0.15mmol over 20mins
Aminophylline 10mg/kg loading dose
Iv salbutamol 5mcg/kg/min for 1 hr
ICU
Bronchiolitis - Organisms
RSV - 70%
Rhinovirus
Parainfluenza/ Influenza
Adenovirus
Humanmetapneumovirus
Bronchiolitis - High Risk
< 10 wks old
GA <37 wks
Chronic lung disease
Congenital heart disease
Indigenous
Immunodeficient
Bronchiolitis - Ix
CXR - alternative dx: Cong Heart Dx, Bact Pneumonia
VBG - resp failure
BSL - metabolic disorder/feeding impairment
Bronchiolitis - Admission Criteria
Age <3m.o
O2 requirement
Severe dehydration/poor feeding
Apnoeic episodes
Bronchiolitis - Treatment
Supportive mainly
NGT 2/3rd maintenance
Oxygen - Low flow SpO2 <90%
HFNP up to 2L/kg
