Paeds Resp

Question 1

When CAN salbutamol be trialled in kids?

Answer 1

NOT <12mo (will be bronchiolitis)

CAN TRY 1-5yo (VIW)

YES >5 years (asthma likely)

Question 2

Bronchiolitis: about

Answer 2

< 12mo

Viral LRTI
–> Fixed obstruction to small airways from inflammation. NOT from reversible bronchospasm
–> Mucus, debris, oedema.

Clinical diagnosis that doesn’t need investigations

7-10 day illness that peaks on day 2-3

Most mild, self-lim, Mx at home.

Question 3

Bronchiolitis: management

Answer 3

1- Minimal handling

2- Oxygen
- If hypoxia persistent. Not for transient desats in the infant.
- Aim sats > 90%
- May need to clear nostrils PRN with saline/suction
–> HFNP: 2L/kg/min (max 50L)
–> Nasal CPAP: 5cm H20 (max 8)

3- Hydration/feeding
- NGT
- Usual 2/3 maint fluids with 5% dex
- Unless severe + and at risk of intubation: supplemental oral comfort feeds

Question 4

Criteria for admission in bronchiolitis:

Answer 4

Requiring O2: Sats persistently <90-92%
Requiring hydration: <50% intake over 12 hours

Risk factor for deterioration:
- <10wo (chron)
- CHD, CLD, immunosuppressed, ATSI.

Question 5

Criteria for discharge in bronchiolitis:

Answer 5

Sats persistently >90-92%
Intake at least 50%
No risk factors
Parents happy
Follow up within 24 hours

Question 6

Max HFNP before changing to CPAP:

Answer 6

2L/kg/min, 40% FiO2

Question 7

Max CPAP before changing to intubation:

Answer 7

8cm H20, 40% FiO2

Question 8

Viral Induced Wheeze:

Answer 8

Zone between bronchiolitis (<12mo) and asthma (5yo+)

Preschoolers (1-5yo)

Pathophysiologically, similar to asthma: oedema, mucus, and bronchospasm
–> Ie. Treat as per asthma
–> May find salbumatol ineffective <2yo, because may actually be bronch

Fewer than half will go on to be asthmatics. Most outgrow by 6yo.

Question 9

Why is asthma not diagnosed before 5yo?

Answer 9

Requires PERSISTENT pattern at/beyond this age.

Most kids (60%) with VIW outgrow it by 6yo.

Question 10

Differential for paediatric WHEEZE:

Answer 10

ALL
- Pneumonia
- Pertussis
- Aspiration
- Anaphylaxis
- Heart failure (CHD, myocarditis)

NEONATE
- Meconium aspiration
- Tracheomalacia
- Bronchiectasis
- TOF
- GORD

INFANT
- Bronchiolitis (<12mo)
- Foreign body
- GORD
- Bronchopulmonary dysplasia

CHILD
- Viral-induced wheeze (1-5)
- Asthma (5+)
- Foreign body
- Other pneumonitis (tox, drowning)

Question 11

Croup: About

Answer 11

Viral laryngotracheobronchitis

Usually parainfluenza. RSV, COVID, influenza

6 months - 6 years (usually <4yo)
UNCOMMON <6mo, RARE <3mo –> consider DDx.

Can be 7-10 day illness, peaks day 2-3
Worse at night

Question 12

Croup: Severity

Answer 12

Question 13

Croup: Management

Answer 13

MILD/MOD:
- 0.15mg Dexamethasone PO (max 12) or 1mg/kg Prednisolone PO daily x3.
- DC 30mins post (+stridor-free at rest)

SEVERE:
- Minimise handling (carer, adopt position of comfort, avoid ENT exam/ swabs etc.)
- 0.6mg/kg (max 12mg) Dexamethasone
- Nebulised adrenaline 5mg
–> DC 4 hours post-adrenaline
–> If >1 adrenaline required- admit.

CRITICAL:
- PICU + anaesthetics
- O2 via NRBM
- Continuous nebulised adrenaline
- Prepare to intubate, have needle-cric ready.
- IV dexamethasone 0.6mg/kg

Question 14

Important croup differentials:

Answer 14

Anaphylaxis

Quinsy
Retropharyngeal abscess

Epiglottitis
Foreign body (supra or subglottic)
Laryngomalacia/ Tracheomalacia (<2yo)

Bacterial tracheitis
Vascular ring