pedi pulm Flashcards
epiglottitis
- inflammation of supraglottic region
- epiglottis, vallecula, arytenoids, aryepiglottic folds
who gets epiglottitis
- usu kids < 6 mo*
- rare in US d/t immunizations
causes of epiglottitis
- strep pyogenes
- strep pneumo
- staph
- less likely to be h flu in peds
si/sx of epiglottitis
- rapid onset
- starts with mild sore throat and fever -> sudden progression
- muffled voice/ hot potato
- drooling
- labored breathing, tripoding
- air hunger
- stridor= late finding
- restlessness
- pre apnea/hypoxia -> coma -> death
dx of epiglottitis
- clinical dx*
- xray rarely needed but shows thumb print sign
- direct visualization with intubation and endoscopy
tx of epiglottitis
- contact anesthesia STAT for intubation
- keep pt calm
- estab O2 and 2 lines if pt will tolerate
- IV ceftriaxone or cefotaxime
- supportive care
prognosis of epiglottitis
- if airway is established it is a good prognosis
- intubation 2-3 d
- NOT contagious
when would you treat prophylactically for epiglottitis
- umimmunized or immunocomp family contacts
- child < 6 mo without HIB vaccine complete
croup
- barking seal cough
- occurs between 10 pm and 4 am
- inflammation of larynx and trachea- subglottic
what causes croup
- virus*
- usu parainfluenza 1,2,3
- may be influenza A or B, adenovirus, RSV
what age do kids get croup
- 3 mo to 5 years
- peak at 2 years
- usu in fall and spring
si/sx of croup
- URI sx days 0-2
- barking cough days 0-5, +/- stridor
- occurs between 10 pm- 4 am
- resolves within 5-7 d
- barking cough worsens days 2-3*
PE for croup
- assess general appearance
- smaller pts tend to look sicker
- rhinorrhea
- laryngitis/ hoarseness
dx of croup
- clinical*
- no xray unless concern for FB
- consider rapid strep if sore throat
tx of mild croup
- cold night air, open freezer door
- humidifier
tx of mild- mod croup
- decadron IV solution given orally 0.6 mg/kg
- max dose= 10 mg
- can send home
tx of mod-severe croup
- decadron IV solution given orally
- racemic epi by neb- 2 hours, repeat PRN
- watch for 2-3 hours for recurrence
- if recurrence or no improvement give second racemic, IM epi
- consider transf to PICU
prognosis of croup
- good prognosis
- self resolving 5-7 days
bacterial tracheitis
- urgent/ emergent condition
- can cause complete respiratory failure by blocking trachea
- purulent d/c
- may be complication of croup
bronchiolitis
- inflammation of lower respiratory tract/ bronchioles
- secretions in inflamed bronchial tree
who gets bronchiolitis
- kids < 2 yr
- greatest morbidity/ mortality if underlying cardiopulm dz or < 2mo
cause of bronchiolitis
- viral cause*
- mainly RSV
- can be parainfluenza, adenovirus
- if bacterial most likely to be myocplasma
how is bronchiolitis spread
- respiratory droplets
si/sx of bronchiolitis
- begins with URI
- copious clear rhinorrhea
- low grade fever
- dev expiratory wheeze +/- crackles
- usu seen in late fall/ throughout winter
- rapid breathing
- poor feeding
- irritability
PE findings for bronchiolitis
- fever of 102
- tachycardia/ tachypnea
- respir distress
- HEENT normal except rhinorrhea
- wheezing lungs*
- if decreased breath sounds- impending doom
- normal O2 or hypoxic
dx of bronchiolitis
- CXR if first episode of wheezing or considering pneumonia
- PCR for RSV with nasal washing
tx of bronchiolitis as outpatient
- supportive care
- fluids
- tylenol, motrin
- edu to return if worening or respiratory distress
tx of bronchiolitis as inpatient
- O2 support
- consider CPAP or high flow O2
- no chest PT
- intubation if impending respiratory failure
who should be admitted for bronchiolitis
- O2 less than 91-93% if awake
- O2 < 91% if asleep
- if intubated/ risk of intubation need PICU
- premie < 12 wks of life
- any suggestion of respiratory distress d 1-3 of illness
- underlying cardiopulm dz
- parents unable to care for child at home
- child that worries you
course of bronchiolitis
- worsens days 2-5
- avg course 10-12 days
- 40% will wheeze again
- very contagious
prevention of bronchiolitis
- hand hygiene
- vaccine ppx with synergis but very expensive, not used
pertussis
- aka whooping cough
- d/t bortadella pertussis
- tdap and dtap immunizations but needs booster
how is pertussis spread
- via respiratory droplets
stages of pertussis
- catarrhal
- paroxysmal
- convalescent
catarrhal stage of pertussis
- most contagious
- can last 1-2 weeks
- similar to cold sx
paroxysmal stage of pertussis
- lasts 1-6 weeks
- can persist for up to 10 weeks
- bursts/ paroxysms of cough -> long inhaling effort making the high pitched whoop
- often appear ill and distressed
convalescent stage of pertussis
- may last for months
- paroxysms may return when pt suffers subsequent respiratory infx
sx that are assoc with paroxysms in pertussis
- respiratory distress
- tongue protruding
- face purple/ blue
- eyes bulging, watering
- posttussive emesis and exhaustion
dx of pertussis
- nasopharyngeal swab (takes days- weeks for results)
- high clinical suspicion
treatment of pertussis
- tx before results of swab
- zithromax
- supportive care
complications of pertussis
- usually none*
- ear infection
- loss of appetite
- dehydration
- pneumonia
- rib fx
- LOC
- urinary incontinence
- hernias
- angina
- encephalopathy or seizures from hypoxia
foreign body aspiration -> partial obstruction
- stridor
FB aspiration -> complete obstruction
- silence
- no airway -> no oxygenation -> no ventilation -> tissue death
when do most FB aspirations occur
- peak incidence 1-2 y/o
- 80% of episodes < 3 y/o
why do FBA occur in young kids
- small airway diameter
- explore orally, dev fine motor skills
- dont have molars to chew properly
what do kids aspirate
- peanuts*- half of all FBA
- seeds, nuts, popcorn, hot dogs
- hardware, toys, batteries, coins
- food most common in infants/ toddlers
- non-food most common in older kids
what causes fatal aspirations
- balloons*
- marbles
- balls
- toys
- “anything strong, round, unbreakable”
where do FB lodge
- adults= R main stem bronchus
- kids= proximal bronchus, no predominance of R over L
when to suspect FBA
- chocking- witnessed event
- wheezing
- formerly speaking and now wont speak
- coughing without URI sx
presentation of acute FBA
- usu presents within 24 hours of FBA
- respiratory distress
- cyanosis
- AMS
- can be life threatening
presentation of less acute FBA
- non-emergent
- classic triad:
- wheezing
- decreased air entry esp regionally
- cough
dx of FBA
- hx is key
- xrays may be helpful
- bronchoscopy- dx and FB removal
complications of FB removal
- dislodgement or breakage with adv into bronchioles or lungs
- infx by prolonged FB
- inflammation- may require steroid burst
respiratory distress syndrome (RDS)
- occurs in preterm infants
- increased risk if born < 30 wks
- majority of all cases < 28 wks
- white males at increased risk of late preterm or full term
etiology of RDS
- surfactant def -> atelectasis -> V/Q mismatch -> pulm inflam response -> potential lung injury and pulm edema
- surfactant def d/t quantity and quality
- prematurity also increases risk of PDA and PFO -> hypoxemia
clinical manifestations of RDS
- tachypnea
- nasal flaring
- grunting- expiratory
- retractions
- decreased breath sounds
- pallor
- diminished periph pulses
- periph edema
- poor urine output
dx of RDS
- clinical
- CXR- testing can be lifesaving
- ABG- hypoxia
- hyponatremia from water retention
interventions to prevent RDS
- antenatal steroids
- exogenous surfactant
- assisted ventilation
- thermoregulation
- fluid mgmt
- CV mgmt
- nutritional support
how is exogenous surfactant delivered for RDS
- given to preterm infants < 30 weeks with respiratory distress, apnea, fail cpap
- admin via endotracheal tube within 30-60 min of life
