Paeds conditions Flashcards
Causes and symptoms of bronchiolitis?
caused by RSV (80%) and adenovirus/influenza/parainfluenza (20%)
Symptoms:
3 days - prodrome, harsh cough
3 days - fever, wheeze, insp. crackles and dyspnoea
3 days recovery
examination signs of bronchiolitis?
red flags?
low grade fever insp crackles expiratory wheeze sub/inter costal recession grunting / nasal flare increased respiratory rate tachycardia
red flags:
cyanosis
difficulty breathing
no wet nappy for 12 hours
when should you admit a child with bronchiolitis?
dehydrated RR>70 or recession/grunting apnoea episodes <50% milk/fluid intake appears exhausted SpO2 <92%
investigations and treatment for bronchiolitis?
investigations:
- clinical diagnosis (check pulse oximetry)
- more severe = cap gas, ?CXR, ?nasal swab
treatment:
mild - home and safety net
moderate - admit, support O2 (HF nasal cannula) and feeding
severe - ICU/HDU, CPAP, Vent, IV fluids
risk factors for bronchiolitis?
Trisomy 21 <6 weeks Congenital cardiac defects premature chronic lung disease
asthma triggers?
pets dust cold exercise viral illness mould aspirin pollen cig smoke
Risk factors for asthma?
family or personal history preterm at birth low birthweight hygiene hyp. maternal smoking/infection males
child presents with wheeze, dry cough, chest tightness what are the differentials?
asthma viral infection ciliary dyskinesia foreign body bronchiectasis
what are the symptoms of asthma?
what are the signs/symptoms of acute severe asthma?
dry cough, wheeze, chest tightness, dyspnoea, responsive to bronchodilators
acute asthma: - low Sp02 (<92%) - tachycardia (>130) -high res rate (>35) - wheeze ! - cyanosis ! - silent chest/exhaustion ! - hypotension
what is the management ladder for acute severe asthma?
initial - AtoE assessment + oxygen (high flow via facemark 15L/min to 94%)
1st line: neb salbutamol neb ipratropium bromide hydrocortisone prednisolone
2nd:
senior escalation
IV magnesium sulphate
3rd:
IV aminophylline
4th line:
IV salbutamol
ICU and anaesthetist on the phone
management ladder for long term asthma in under 12’s?
- inhaled SABA
- inhaled ICS (+/- LTRA)
- inhaled LABA + ICS
- +LTRA , or increase ICS
- increase ICS, refer and consider oral steroid
management ladder for long term asthma in over 12’s?
- inhaled SABA + ICS
- inhaled LABA + ICS/LTRA
- LTRA and increase ICS +/- theophylline
- consider oral steroid and refer
what are the symptoms/presentation of croup?
inspiratory stridor barking cough coryzal prodrome low grade fever hoarse voice rapid onset/worse at night/illness prior
cause of croup?
parainfluenza 1 and 2
RSV, adenovirus, influenza
management of croup? what is it important not to do in children with stridor?
A to E assessment vital signs --> assess severity oral dexamethasone \+nebulised adrenaline \+HF oxygen if required
DO NOT examine throat
