Paeds resp Flashcards
What is the age group of bronchiolitis?
Typically occurs between 0-12 months, although can be delayed up til 24months in some case
Peaks days 2-3, typically last 7-10 days
What are the risk factors for bad bronch?
Corrected age < 3months (<10 weeks)
Congenital heart disease
Chronic lung disease
Chronic neurological conditions
Prematurity
Immunodeficiency
Trisomy 21
Indigenous status
Failure to thrive
Breast fed < 2months
Post natal cigarette smoke exposure
What are the signs of severe bronch?
- Increasingly frequent or prolonged Apnoea (intermittent apnoea mod)
- Poor/unable to feed
- sats <90% (02 to aim >92%)
- Marked work of breathing
- Fatigue, lethargy, severely irritable
What is the indications for NG/IV nutrition and rehydration in Bronch?
Feeding <50% over 24hrs or unable to feed
IV fluids can be administered at either 2/3rds or full maintenance rate, unclear what is best
What is the basis of treatment for Bronch?
Assist with feeds
Nasal saline drops around time of feeding +/- nasal suctioning
02 only if sats persistently <92%
HFNP or nasal CPAP
If critical then intubation
What is the Antibiotic regimen in children with mild, moderate and severe pneumonia?
Mild: Amoxicillin 30mg/kg TDS
Moderate: Amoxi, if not tolerating orals then IV benzylpenicillin 60mg/kg QID
Severe: Ceftriaxone and Flucloxacillin 50mg/kg
+ Vancomycin if MRSA suspected
+ Azithromycin 10mg/kg if atypicals suspected or not improving
+ Oseltamivir if flu suspected
What are the most common organisms causing pneumonia in older children?
- Strep pneum (1st)
- Mycoplasma pnuemoniae
- Chlamydia pneumoniae
- Viruses ie adeno, RSV, influenza, covid etc
What are the indications for admission with pneumonia?
- 02 requirement
- Co-morbidities (cardiac, premature, immune, lung etc)
- Concomitant social issues, inability of parents to cope
- Failed outpatient therapy
- Evidence of severity (altered obs, reduced mental status)
- Evidence of empyema on CXR
- Poor oral intake
What are the differentials for hypoxia and respiratory distress in an infant (<12months)?
What are the differentials for wheeze in an infant?
- Bronch
- Tracheobronchial foreign body
- Cardiac wheeze from congenital heart disease
- Viral induced wheeze/asthma
- Pertussis
- ? pneumothorax
What are the differentials for stridor in children?
- Croup
- Anaphylaxis
How should a critical Croup patient initially be managed?
How should intubation of a critical croup patient be attempted?
What are the main indications for bronchoscopy in a child with suspected aspiration of an FB?
- Hyperinflation on a CXR
- Focal unilateral wheeze/atelectasis
- Good history/exam of choking and/or persistent cough post choking
What is the algorithm for the choking child? What are the most important parts on history?
- Age
- Opportunity/access
- coughing/choking
- Sudden onset change
- Absence of prodrome
