Paeds resp Flashcards
What is the stepwise management of an acute asthma presentation?
- High flow oxygen
- Nebulised salbutamol (2.5mg <5 yrs, 5mg >5yrs)
- Nebulised ipratropium bromide (250 mcg)
- Oral prednisolone (20mg <5 yrs, 40mg >5 yrs)
- IV hydrocortisone (4 mg/kg)
What is the stepwise management of a severe acute asthma presentation?
- IV salbutamol bolous + MgSO4
- IV salbutamol infusion or IV aminophyline
- If still not improving add the other from step 2
- Resp support
What is the stepwise management of childhood asthma?
- SABA (salbutamol)
- low dose ICS (beclomethasone)
- LTRA (montelukast)
- LABA (salmeterol) and stop LTRA (differs to adult management)
- Switch LABA/ICS to MART with low dose ICS
- MART with moderate dose ICS
- Specialist management
Asthma respiratory rate:
1. What RR would indicate severe asthma in 1-5 year old
2. What RR would indicate severe asthma in >5 year old
- > 40
- > 30
Asthma heart rate:
1. What HR would indicate severe asthma in 1-5 year old
2. What HR would indicate severe asthma in >5 year old
- > 140
- > 125
Asthma peak flow:
1. What peak flow indicates moderate asthma
2. What peak flow indicates severe asthma
3. What peak flow indicates life threatening asthma
- PF >50% predicted
- PF <50% predicted
- PF <30% predicted
What age group does bronchiolitis typically affect?
Children under 1
What is the most common cause of bronchiolitis?
RSV
What is the management of bronchiolitis?
- Supportive
- Ensuring adequate intake (oral/NG/IV)
- Nasal suctioning
- Supplementary oxygen (if sats <92%)
- Ventilatory support (if required)
What babies are considered high risk for bronchiolitis?
Ex-premature and congenital heart disease
What preventer is given to babies at high risk of bronchiolitis?
Palivizumab - a monoclonal antibody that targets RSV
What 3 features distinguish viral induced wheeze from asthma?
- Presenting < 3 years old
- No atopic Hx
- Only occurs during viral infections
What is the management of viral induced wheeze?
The same as acute asthma
What’s the most common cause of 1) bacterial pneumonia and 2) viral pneumonia?
1) Strep pneumonia
2) RSV
What is often first line treatment for bacterial pneumonia?
Amoxicillin
When is IV antibiotic therapy indicated for pneumonia?
When there is sepsis or a problem with intestinal absorption
The addition of what type of antibiotics would cover atypical pneumonia?
Macrolide (erythromycin)
What age group is typically affected by croup?
Ages 6 months to 2 yrs
Croup is an URTI that results in…
… oedema in the larynx
What is the most common cause of croup?
Parainfluenza
What is the stepwise management of croup?
- Supportive (fluids and rest)
- Oral dexamethasone (single dose 150mcg/kg)
- Oxygen
- Nebulised budesonide
- Nebulised adrenaline
- Intubation and ventilation
What is epiglottis typical caused by?
Haemophilus influenza B
What investigation can be carried out in epiglottis? What would it show?
- Lateral XR of neck
- ‘Thumb sign’
What is the management of epiglottis?
- Inform senior paediatrician and anaesthetist
- Once airway secure - IV abx (ceftriaxone), steroids (dexamethasone)
What is the inheritance pattern of CF?
Autosomal recessive
What is normally the first sign of CF?
Meconium ileus
When is CF first screened for?
Newborn blood spot testing
What is the gold standard test for diagnosing CF?
Sweat test
What is a diagnostic chloride concentration for CF (in sweat test)?
> 60 mmol/L
CF infections:
1. What are the 2 key microbial colonisers in CF
2. What prophylactic antibiotics do patients take and what for
- Staph aureus and pseudomonas
- Prophylactic flucloxacillin for staph aureus
What is whooping cough caused by?
Bordetella pertussis
How long does it take for the symptoms of whooping cough to resolve? What’s it sometimes referred to?
- Within 8 wks
- The ‘100 day cough’ as can last several months
When is a child admitted due to asthma exacerbation deemed stable enough to be discharged? What is the step down salbutamol regime?
When on 6 puffs of salbutamol 4 hourly
Step down:
- 6 puffs 4 hourly for 48 hrs
- 4 puffs 6 hourly for 48 hrs
- 2-4 puffs as required
What dose of dexamethasone is given in croup? When can it be repeated?
150mcg/kg. Can be repeated after 12 hours