PAEDS RESPIRATORY TO DO Flashcards
CROUP
What is the management of croup?
- PO dexamethasone 0.15mg/kg 1st line, can repeat at 12h
- Nebulised budesonide (steroid)
- High flow oxygen + nebulised adrenaline (more severe/emergency cases)
- Monitor closely with anaesthetist + ENT input, intubation rare
ACUTE EPIGLOTTITIS
What is the management of epiglottitis?
- Prevention HiB vaccine, rifampicin prophylaxis for close household contacts
- Do NOT examine throat, anaethetist, paeds + ENT surgeon input
- Intubation if severe, may need tracheostomy
- IV ceftriaxone + dexamethasone given once airway secured
BRONCHIOLITIS
What are some risk factors for bronchiolitis?
- Premature babies
- CHD
- Cystic fibrosis
- Immune deficiency
BRONCHIOLITIS
What are some investigations for bronchiolitis?
- Nasopharyngeal secretions PCR for RSV (immunofluorescence)
- CXR may show hyperinflation due to small airways obstruction, air trapping + foetal atelectasis
- Blood gas (capillary) if severe + ?ventilation > falling O2, rising CO2 + pH
BRONCHIOLITIS
What are some criteria for admission?
- Apnoea
- Severe resp distress (RR>60, marked chest recession, grunting)
- Central cyanosis
- SpO2 < 92%
- Dehydration
- 50–75% usual intake
PNEUMONIA
How can CXR indicate what the causative organism may be?
- Lobar consolidation (dense white area in a lobe) = pneumococcus
- Rounded air-filled cavities (pneumatoceles) + multi-lobar = S. aureus
PNEUMONIA
What is the management of pneumonia?
- Newborns = IV broad-spec Abx
- Older = PO amoxicillin with broad-spectrum Abx (co-amoxiclav) if unresponsive or influenza
- Macrolides (erythromycin) to cover for mycoplasma, chlamydia or if unresponsive
ASTHMA
What are the characteristics of asthma?
- Airflow limitation due to bronchospasm (reversible spontaneously or with Tx)
- Airway hyperresponsiveness to various triggers
- Bronchial inflammation
ASTHMA
What are the RCP3 questions and what are they used for?
Assessing asthma severity
– Recent waking in the night?
– Usual asthma Sx in the day?
– Interference with ADLs?
ASTHMA
What is the mechanism of action for SABAs?
- Adrenaline acts on smooth muscles of airways > dilation,
- acts fast but lasts only few hours
ASTHMA
What is the mechanism of action for LTRA?
Leukotrienes produced by immune system > inflammation, bronchoconstriction + mucous secretion in airways so blocks this
ASTHMA
What are the important side effects of SABAs?
Hypokalaemia,
tremor
ASTHMA
What is the stepwise management of chronic asthma in <5y?
- SABA
- SABA + 8-week trial of MODERATE dose ICS
- SABA + LOW dose ICS + LTRA
- stop LTRA and refer to paeds asthma specialist
ASTHMA
What is the stepwise management of chronic asthma >5y?
- SABA
- SABA + LOW dose ICS
- SABA + ICS + LTRA
- SABA + ICS + LABA
- SABA + MART (includes LOW dose ICS)
- SABA + MART (includes MODERATE dose ICS) / SABA + MODERATE dose ICS + LABA
- SABA + HIGH dose ICS/theophylline and seek advise from expert
ASTHMA
What are some reasons for failure to respond to treatment for asthma?
ABCDE –
- Adherence (#1)
- Bad disease (dose inadequate for severity)
- Choice of drug/device (different pts respond differently)
- Diagnosis (?correct)
- Environment (?trigger)
ASTHMA
What is classed as a life-threatening asthma exacerbation?
- PEFR 33% predicted
- Exhaustion/cyanosis
- Poor respiratory effort
- Altered consciousness, hypotension
- Silent chest (airways so tight no air entry)
- SpO2 <92%
ASTHMA
What are some investigations for exacerbation of asthma?
- Monitor RR, peak flow, SpO2, chest auscultation
- ECG monitoring for arrhythmias (low K+ from SABA + steroids)
- ABG = initial resp alkalosis as tachypnoea causes drop in CO2, normal pCO2 or hypoxia concerning as indicates exhaustion, resp acidosis from high CO2 very bad sign
ASTHMA
What is the management of exacerbations of asthma?
O SHIT ME –
- Oxygen (SpO2 94–98%)
- Salbutamol (spacer or neb B2B, IV if no response to this + ipratropium as 2nd line)
- Hydrocortisone IV or PO pred
- Ipratropium bromide (neb if poor response to salbutamol)
- Theophylline (IV)
- Magnesium sulfate (IV)
- Escalate early > ICU if not improving for ventilation ± intubation
CYSTIC FIBROSIS
What is the pathophysiology of cystic fibrosis?
- Decreased Cl- excretion into airway lumen + increased reabsorption of Na+ into epithelial cells means less excretion of salt (+ so water) > increased viscosity of airway secretion
CYSTIC FIBROSIS
How does cystic fibrosis present in older children + adolescents?
- DM (pancreatic insufficiency)
- Cirrhosis + portal HTN
- Distal intestinal obstruction
- Pneumothorax or recurrent haemoptysis
- Sterility in males as absent vas deferens
CYSTIC FIBROSIS
What are some signs of cystic fibrosis?
- Low weight or height on growth charts
- Hyperinflation due to air trapping
- Coarse inspiration crepitations ± expiratory wheeze
- Finger clubbing
CYSTIC FIBROSIS
What are some typical causes of respiratory tract infections in cystic fibrosis?
- S. aureus
- H. influenzae
- Pseudomonas aeruginosa
- Bulkholderia cepacia associated with increased morbidity + mortality
CYSTIC FIBROSIS
What are some investigations for cystic fibrosis?
- Guthrie test = raised immunoreactive trypsinogen
- Sweat test = gold standard
- Low faecal elastase = pancreatic insufficiency
- Genetic testing for CFTR gene during pregnancy with amniocentesis or CVS
CROUP
How do you assess croup severity?
Westley score for severity
(chest wall retractions, stridor, cyanosis, air entry + consciousness)
