Paeds: Resp + ENT Flashcards
Respiratory red flags in paeds
when to admit via ambulance
Apnoea Looks unwell (mottled/blue) Severe respiratory distress (grunting, chest recession, RR >70bpm) Central cyanosis Persistent SpO2 < 92% (air) Decreased skin turgor Does not wake if roused
Amber red flags in paeds
when to consider admitting
RR > 60 bpm Difficulty breastfeeding decreased oral intake (50-75% of usual) Clinical dehydration Crackles on auscultation Nasal flaring Dry mucous membranes Pallor Decreased nappy wetting
"Whooping cough" caused by vomiting Coryza (2-3 days) Cyanosis Subconjunctival haemorrhages (from persistent coughing) Paroxysmal cough Apnoeic attacks
Pertussis
- caused by bordetella pertussis (gram neg)
- can last 10 weeks
Cause of Pertussis
bordetella pertussis
Investigations for pertussis
nasal swab
Management of pertussis
< 6 months old: Admit
Azithromycin/ Clarithromycin/ erythromycin
- if cough onset in 21 days
Can return to school 48hr from starting ABx
Respiratory distress in premature babies
Respiratory distress syndrome (RDS)
“Hyaline membrane disease”
Surfactant deficiency in alveoli leads to:
- alveolar collapse
- reduced lung volumes
- reduced lung compliance
Surfactant is produced at
24weeks gestation
- not sufficient quality until 34 weeks (hence why RDS affects premature babies)
- produced in T2 alveolar cells
Risk factors for RDS
Males Maternal diabetes IUGR <29w C-section Second twin delivered
Management for RDS
- Give mother dexamethasone to induce foetal lung maturation
- Surfactant (Curosurf) via ETT, given in first 6 hours since birth (pig lung extract)
- CPAP
Most common cause of respiratory distress in newborns
Transient tachypnoea of the newborn (TTN)
- Delayed reabsorption of the fluid into the lungs
- Common in C-sections
- XR: Hyperinflation of the lungs
fluid in the horizontal fissure
Transient tachypnoea of the newborn (TTN)
Management of TTN
O2
Self resolves in a few days
Age: 6 months - 3 years
Barking cough
Stridor
Common in Autumn
Croup
- caused by Human Parainfluenza viruses (HPIVs)
- don’t examine airway due to risk of obstruction
Cause of croup
caused by Human Parainfluenza viruses (HPIVs)
CXR: Steeple sign
Croup
Management of Croup
Dexamethasone (oral) + O2
- 0.15mg/kg
Severe: Nebulised adrenaline + O2
The 3 Ds
- Drooling
- Dysphagia
- Distress
Tripod position:
- learning forward
- extending neck
- seated
Rapid increasing fever
High pitched sound on inspiration
Acute epiglottitis
- caused by Haemophilus influenzae Type B
- seen in unvaccinated kids
Cause of acute epiglottitis
caused by Haemophilus influenzae Type B
Lateral CXR: Thumb print sign
Acute epiglottitis
Management of Acute epiglottitis
Senior help
O2
IV ABx
Management of pneumonia in paeds
- Amoxicillin
- Macrolides (Erythromycin)
If associated with flu: Co-amoxiclav
If mycoplasma pneumoniae/ chlamydia: Macrolides
Cause of pneumonia in paeds
Strep pneumoniae
Age: <12 months (usually 3-6m) Grunting Corzyal symptoms SOB Common in winter months
Bronchiolitis
- caused by
1. Respiratory Syncytial virus (RSV) - 80%
2. Mycoplasma - worse symptoms if VSD
CXR: Overinflated lungs
Perihilar haze
Scattered atelectasis
Immunofluerence of nasopharyngeal secretions
Bronchiolitis
Bronchiolitis is caused by
- Respiratory Syncytial virus (RSV) - 80%
2. Mycoplasma
Risk factors of bronchiolitis
Downs syndrome
Formula milk
<3m old
Premature
Management to reduce future episodes of bronchiolitis
RSV Immunoglobin
Palivizumab
Management of bronchiolitis
Humidified O2
NG feeds
Suction for airway secretions
Heavy breathing
Stridor
Congenital softening of the cartilage of larynx
Laryngomalacia
Tx: Self resolving
Cyanosis when feeding
Posterior airway is occluded by soft tissue or bone
Choanal atresia
Tx: Fenestration procedure
Respiratory distress in newborn
Meconium in trachea
Common in post term babies
Risk factors:
- maternal HTN
- Pre-eclampsia
- chorioamnionitis
- smoking/ drug abuse
Meconium aspiration syndrome
