ped pulm test 2 Flashcards
at what weeks of life is a baby highest risk for RDS (respiratory distress syndrome)
<28 weeks = 60 to 80%
increased risk for RDS
Infants of Diabetic Mothers
Multifetal pregnancies
C-section
Family History
Primary Cause –
Surfactant Deficiency
signs of RDS
Signs within minutes of birth: Tachypnea Grunting Intercostal and subcostal retractions Nasal flaring Duskiness
PE findings in RDS
Diminished breath sounds
Falling blood pressure
Pallor
Progresses to, Apnea and
Mixed resp/metab acidosis
how to DX RDS
Clinical Course
CXR – ground glass appearance
ABG
RDS prevention
Beta methasone 48 hours prior to delivery between 23 – 34 weeks
t/f beta methasone Should be administered at 23 – 34 weeks gestation if increased risk of preterm delivery in next 7 days
true
RDS tx
Careful and frequent monitoring
Warm humidified O2 to keep arterial levels between 55 – 70 (sats >90%)
when do you give surfactant in RDS
If intubation (or CPAP) needed at birth after initial stabilization infants
with hypoxic respiratory failure attributable to secondary surfactant deficiency
Inflammation of the bronchioles – usually caused by an acute viral infection
Most common lower respiratory tract infection in infants and children <2yo
Bronchiolitis
common causative agents in bronchiolitis
RSV
Adenovirus, human metapneumovirus, influenza, parainfluenza
how to dx bronchiolitis
Based on history and physical exam
Routine lab and radiologic studies not recommended
bronchiolitis upper resp presentation
uri, runny nose
bronchiolitis lower resp presentation
Cough
Tachypnea
Increased Respiratory Effort
other bronchiolitis findings
Apnea in very young infants
Elevated RR – earliest and most sensitive sign
Tachycardia
Due to dehydration and hypoxemia
Illness severity – determined by ?
RR, work of breathing, hypoxia
what days are the peak of bronchiolitis
3 and 4
bronchiolitis cxr findings
hyperinflation, atelectasis, infiltrates,
does not correlate with disease severity or guide management
who do you check for sepsis if they have a fever?
< 60 day olds
management of bronchiolitis
hydration
o2
broncho dilators/steroids (not typical)
nasal suction
rivavirin (sever)
influenza antivirals
leading cause of infant death (viral)
RSV
who is RSV most sever in
children with cardiovascular disease,
infants born prematurely
infants with chronic lung disease
premature <6 mo old
RSV testing
rapid antigen
does not alter tx
common RSV complications
otitis media
Bacterial pneumonia
drug used to prevent RSV
synagis (big money)
when can you use synagis
born at less than 29 weeks
born at less than 32 weeks with O2 requirement for at least 28 days after birth (Chronic Lung Disease
Infants less than 24 months of age with CLD still requiring medical intervention
one of most common causes of ed visits
asthma
common onset of asthma
prior to 6 yr
what does asthma look like
Intermittent dry coughing and expiratory wheezing
SOB and chest tightness in older children
Symptoms worse at night
asthma triggers
Physical exertion Hyperventilation (laughing) Cold or dry air Airways irritants Inhaled allergens
asthma PE findings
Expiratory wheezing, prolonged expiratory phase
Decreased Breath Sounds (regional hypoinflation due to airways obstruction)
Retractions, accessory muscle use
barky cough, hoarseness, inspiratory stridor
croup
happen before croup
URI symptoms for 1 – 3 days before the symptoms of upper airway obstruction
age of croup onset
Occurs in 3 month – 5 years of age, peak in second year of life
what “bug” causes croup
parainfluenza viruses
Also: influenza, RSV, adenovirus
clinical sign on x ray of croup
steeple sign
how do we manage croup
Usually managed at home
Cool mist
Steamy bathroom for exacerbations
how do we manage croup in the hospital
Nebulized racemic epinephrine
Corticosteroids
when do we hospitalize for croup
Progressive stridor Severe stridor at rest Respiratory distress Hypoxia Cyanosis Depressed mental status
Acute, fulminating course of high fever, sore throat, dyspnea, rapidly progressing respiratory obstruction
epiglottitis
what vaccine lowers the risk of epiglottits
HiB
what currently causes epiglottits
due to Streptococcus pyogenes, Streptococcus pneumoniae, and Staphylococcus aureus
what do you see with epiglottitis
“cherry-red” swollen epiglottitis
drooling
tripod
fast onset
management of epiglottits
intubate
Oxygen
Culture blood, epiglottis
abx for epiglottitis
Ceftriaxone, cefixime or combo of ampicillin and sulbactam
street names for pertussis
Whooping cough
Bordetella pertussis
what are the stages of pertussis
6 week course
- Catarrhal
- Paroxysmal
- Convalescent
what pertussis looks like
cough especially in the absence of fever, malaise, myalgia, exanthema or sore throat
how to dx pertussis
Leukocytosis with absolute lymphocytosis
Culture is gold standard, but do not wait on results to treat
Reportable disease
tx of pertussis
Erythromycin or azythromycin
who do we hospitalize with pertussis
Infants under 3 months of age
3- 6 months with severe paroxysms
Premature infants or children with cardiac, pulmonary, muscular or neurologic disorders
