Paeds Resp Flashcards
What is pneumonia?
Infection of the lower respiratory tract and lung parenchyma causes inflammation of the lung tissue & sputum filling the airways and alveoli
What are resp distress symptoms
tracheal tug
intercostal + diaphragm recession
nasal flaring
RR>60
accessory muscle use
wheeze
stridor
cyanosis
head bobbing
What is wheeze
obstructed lower airway
Expiratory whistle
asthma
bronchiectasis
CF
bronchiolitis
what is stridor
obstructed upper airway
high pitched harsh inspiration
croup
epiglottitis
laryngomalacia
foreign body
What is order of choice of oxygen supplementation
high flow O2
CPAP
intubation
How does pneumonia present?
- Usually precede an upper respiratory tract infection
- Cough (typically wet and productive)
- Fever
- SOB
- poor feed
- Lethargy
- Increased work of breathing
What are the characteristic auscultation chest signs of pneumonia?
Bronchial breathing
Focal coarse crackles
Dullness to percussion
Is bacterial or viral pneumonia more common in young infants
viral pneumonia is more common in young infants
What are the signs of pneumonia?
Tachypnoea (raised respiratory rate)
Tachycardia (raised heart rate)
Hypoxia (low oxygen)
Hypotension (shock)
Fever
Confusion
What is the most common cause of pneumonia in neonates
Group B Strep, E coli, Klebsiella, Staph Aureus
What is the most common bacterial cause of pneumonia in children?
Streptococcus pneumonia
What is the most common cause of pneumonia in infants?
Strep pneumoniae, HiB, Chlamydia
haemophilus influenzae type b
What is the most common cause of pneumonia in school age children?
Strep pneumoniae, Mycoplasma pneumoniae, Haemophilus influenza,
Staph Aureus, group A Step,
What are the typical XRay findings of pneumonia?
upper lobe consolidation
What are the viral causes of pneumonia?
Respiratory syncytial virus (RSV) (MC)
Parainfluenza virus
Influenza virus
What Xray findings would you see for Staphylococcus aureus pneumonia?
pneumatocoeles (round air filled cavities) and consolidations in multiple lobes.
What are the investigations of pneumonia?
Clinical
FBC + bloods
Sputum culture and Gram stain:
CXR - fluid in the lungs (associated with Staph)
What is 1st line antibiotic for pneumonia?
Amoxicillin
Neonates: Broad spec IV Abx
Infants: Amoxicillin/Co-Amoxiclav
Over 5s: Amoxicillin/Erythromycin
What antibiotic is added to cover atypical pneumonia or in case of patient with penicillin allergy?
macrolide - erythromycin, clarithromycin or azithromycin
Name complications of pneumonia
Respiratory failure
Sepsis
Pleural effusion (in 1/3 cases)
Empyema
Lung abscess
Risk of parapneumonic collapse and empyema if so follow up at 4-6 weeks with a fluid sample
When should child be admitted for pneumonia
<93% O2 stat
What is croup
Acute laryngotracheobronchitis due to parainfluenxa virus
upper respiratory tract infection causing inflammation in the larynx
What is the classic cause of croup
parainfluenza virus
What is the epidemiology of croup
Peak incidence 6 months to 3 years
MC in autumn and winter
more common in male, preterm, and those with underlying resp disease
Name 3 causes of croup
Parainfluenza - MC
Influenza
Adenovirus
Rhinovirus
What did croup used to be commonly caused by and what did it lead to?
Croup caused by diphtheria leads to epiglottitis
what is the pathophysiology of croup?
Viral infection –> inflammation of the upper airway with oedema formation and infiltration of inflammatory cells –> narrowing of subglottic airway (inspiratory stridor) and increased work of breathing
What is mild croup
Occasional barking cough
No audible stridor at rest
No or mild suprasternal and/or intercostal recession
The child is happy and is prepared to eat, drink, and play
what is moderate croup
Frequent barking cough
Easily audible stridor at rest
Suprasternal and sternal wall retraction at rest
No or little distress or agitation
The child can be placated and is interested in its surroundings
what is severe croup
requent barking cough
Prominent inspiratory (and occasionally, expiratory) stridor at rest
Marked sternal wall retractions
Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)
Tachycardia occurs with more severe obstructive symptoms and hypoxaemia
When do you admit a child with croup?
moderate or severe croup
< 3 months of age
stridor at rest
known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
What are respiratory failure red flag signs?
- Drowsiness
- Lethargy
- Cyanosis
- Tachycardia
- Laboured breathing
How does croup present on examination?
- 1-4 days history of non-specific rhinorrhea (thin, nasal discharge), fever and barking
cough - Worse at night
- Stridor
- Decreased bilateral air entry
- Tachypnoea
- Costal recession
How is croup diagnosed?
- clinical dx
- FBC, CRP U+E
- CXR
What are the XRay signs of croup?
steeple sign = subglottic narrowing
thumb sign = swelling of the epiglottis
How is croup managed?
- Single dose oral dexamethasone 0.15mg/kg
- Paracetamol/Ibuprofen for fever/sore throat
- Admission if moderate/severe and consider if dehydrated
- Nebulised adrenaline for relief of severe symptoms
- Oxygen if required
- Monitor for needed ENT intervention if suspected airway blockage
What are complications of croup?
- Bacterial Superinfection: (S. Aureus, pseudomembranous croup, thick green secretions Tx IV fludox)
- Otitis Media
- Dehydration due to reduced fluid intake
What is asthma?
chronic reversible airway obstruction characterised by mucus hyper-secretions, airway hyper-responsiveness and inflammation
What are causes/RH of asthma?
- FHx atopy
- PHx atopy
- Samter’s Triad
- Hygiene hypothesis
- Genetic
- Prematurity
- Low birth weight
- Parental smoking
- Viral bronchiolitis in early life
- Cold air
- allergen eg dust pollution
patients with asthma also suffer from other IgE-mediated atopic conditions such as
atopic dermatitis (eczema)
allergic rhinitis (hay fever)
How does asthma present clinically?
Persistent recurrent resp distress with wheeze, worse at night and in morning
- Episodic symptoms with intermittent exacerbations
- Dry cough often worse at night
- SOB
- Wheeze
- Reduced peak flow
- Expiratory wheeze on auscultation
What is harrisons sulci
muscles insertions at diaphragm visible
associated with chronic asthma
How is asthma investigated >5 y/o
- PEF diary -> 20% variable in 2-4 week period
- CXR (hyperinflation)
- FEV1:FVC < 0.8
- Bronchodialtor >12% reversibility
What would spirometry investigation for asthma show?
- FEV1 significantly reduced
- FVC normal
- FEV1:FVC may be <70% if poorly controlled
- Reversible spirometry is highly suggestive of asthma
