Paeds Written - RESP Flashcards
MILD CROUP Features
Occasional barking cough
No stridor
No sternal/intercostal recessions at rest
Happy child - eats, drinks, plays
Factors that may impact decision to admit child with Croup?
Moderate (or above) illness severity
Mild illness but other concern:
- age <3 months
- chronic lung disease
- congenital heart disease
- neuromuscular disorder
- immunodeficiency
- poor fluid intake/wet nappies
- long distance to healthcare
- concerns re: parents coping
Signs of impending respiratory failure in croup
Asynchronous chest wall movements Fatigue Pallor/cyanosis RR > 70 Tachycardia Decreased consciousness
Most important Tx for croup
Single dose oral dexamethasone 0.15mg/kg
- can be repeated after 12 hours
- prednisolone is alternative
Croup Signs & Sx
Wheeze Dry cough Coryzal Sx Poor feeding dyspnoea ?resp distress
O/E: fine, bi-basal, end expiratory crackles
Factors that may require hospital admission in child with bronchiolitis?
Resp distress
- head bobbing
- tracheal tug
- acc muscle use
- nasal flaring
- high RR, cyanosis
Poor fluid intake
Grunting
Apnoea
Sp <90-92% on room air
+ lower threshold if <2 months OR existing disease
What bronchiolitis-causing agent requires PICU care?
Human meta-pneumovirus
Rare though
Acute asthma / VIW management pathway
1a. O2 + Burst therapy
- Salbutamol nebs / MDI with spacer
- + ipratropium bromide
1b. + 1 x oral prednisolone (give early as takes 4-6 hrs)
INVOLVE SENIOR after burst therapy not working
- IV bolus of: Mag Sulph, Salbutamol, Aminophylline (monitor ECG - can cause arrhythmia)
- IV infusion (same as above)
- Intubation + ventilation
Requirements for discharge in acute asthma/VIW
Stable on 4 hourly SABA (salbutamol)
peak flow 75% of best/predicted
Sats >94%
Attend follow up with GP within 2 days
Chronic asthma stepwise Tx (in 5-16 yo)
- SABA
- if not controlled (or presents with Sx 3x/week +) –> SABA + low dose ICS
- SABA + low dose ICS + LRTA
- SABA + low dose ICS + LABA (stop LRTA if no benefit - unlike in adults)
- SABA + MART (incl low dose ICS)
- SABA + mod dose MART (or separate mod dose ICS + LABA)
- SABA + 1 of:
- high dose ICS (separate or part of MART)
- trial of theophylline
- asthma specialist advice!
Chronic asthma stepwise Tx in under 5s
- SABA
- IF Sx not controlled or new Dx with Sx 3x/week + –> SABA + 8 week trial mod dose ICS
- Review + if consistent with asthma (ie. Sx resolved then recurred within 4 weeks) –> SABA + low dose ICS
- SABA + low dose ICS + LTRA
- Seek specialist help + stop LTRA
Epiglottitis Tx
Contact on call Paeds / ENT / Anaesthetist for urgent review + admission
IV dexamethasone
Blood cultures + empirical Abs - cefuroxime
+ Rifampicin for close household contacts
Nutritional support in CF
High calorie + high fat diet
Fat soluble vitamins (ADEK)
Pancreatic enzyme replacement - Pancreatin, CREON?
Overnight gastrostomy tube if diet insufficient
Regular glucose monitoring for possible DM
Mucolytics used in CF
1st line = rhDNase (or inhaled mannitol dry powder if too young)
2nd line = rhDNase + nebulised hypertonic saline
Lumacaftor / Ivacaftor (Orkambi)
- for delta F508 mutation patients
- Lumacaftor increases CFTR protein transported to surface
- Ivacaftor potentiates CFTR at surface –> increased opening
Acute otitis media Abx
1st line = amoxicillin 5 days
If penicillin allergic: erythromycin, clarithromycin