pedi pulm Flashcards

1
Q

epiglottitis

A
  • inflammation of supraglottic region

- epiglottis, vallecula, arytenoids, aryepiglottic folds

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2
Q

who gets epiglottitis

A
  • usu kids < 6 mo*

- rare in US d/t immunizations

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3
Q

causes of epiglottitis

A
  • strep pyogenes
  • strep pneumo
  • staph
  • less likely to be h flu in peds
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4
Q

si/sx of epiglottitis

A
  • 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
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5
Q

dx of epiglottitis

A
  • clinical dx*
  • xray rarely needed but shows thumb print sign
  • direct visualization with intubation and endoscopy
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6
Q

tx of epiglottitis

A
  • contact anesthesia STAT for intubation
  • keep pt calm
  • estab O2 and 2 lines if pt will tolerate
  • IV ceftriaxone or cefotaxime
  • supportive care
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7
Q

prognosis of epiglottitis

A
  • if airway is established it is a good prognosis
  • intubation 2-3 d
  • NOT contagious
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8
Q

when would you treat prophylactically for epiglottitis

A
  • umimmunized or immunocomp family contacts

- child < 6 mo without HIB vaccine complete

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9
Q

croup

A
  • barking seal cough
  • occurs between 10 pm and 4 am
  • inflammation of larynx and trachea- subglottic
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10
Q

what causes croup

A
  • virus*
  • usu parainfluenza 1,2,3
  • may be influenza A or B, adenovirus, RSV
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11
Q

what age do kids get croup

A
  • 3 mo to 5 years
  • peak at 2 years
  • usu in fall and spring
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12
Q

si/sx of croup

A
  • 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*
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13
Q

PE for croup

A
  • assess general appearance
  • smaller pts tend to look sicker
  • rhinorrhea
  • laryngitis/ hoarseness
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14
Q

dx of croup

A
  • clinical*
  • no xray unless concern for FB
  • consider rapid strep if sore throat
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15
Q

tx of mild croup

A
  • cold night air, open freezer door

- humidifier

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16
Q

tx of mild- mod croup

A
  • decadron IV solution given orally 0.6 mg/kg
  • max dose= 10 mg
  • can send home
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17
Q

tx of mod-severe croup

A
  • 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
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18
Q

prognosis of croup

A
  • good prognosis

- self resolving 5-7 days

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19
Q

bacterial tracheitis

A
  • urgent/ emergent condition
  • can cause complete respiratory failure by blocking trachea
  • purulent d/c
  • may be complication of croup
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20
Q

bronchiolitis

A
  • inflammation of lower respiratory tract/ bronchioles

- secretions in inflamed bronchial tree

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21
Q

who gets bronchiolitis

A
  • kids < 2 yr

- greatest morbidity/ mortality if underlying cardiopulm dz or < 2mo

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22
Q

cause of bronchiolitis

A
  • viral cause*
  • mainly RSV
  • can be parainfluenza, adenovirus
  • if bacterial most likely to be myocplasma
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23
Q

how is bronchiolitis spread

A
  • respiratory droplets
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24
Q

si/sx of bronchiolitis

A
  • 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
25
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
26
dx of bronchiolitis
- CXR if first episode of wheezing or considering pneumonia | - PCR for RSV with nasal washing
27
tx of bronchiolitis as outpatient
- supportive care - fluids - tylenol, motrin - edu to return if worening or respiratory distress
28
tx of bronchiolitis as inpatient
- O2 support - consider CPAP or high flow O2 - no chest PT - intubation if impending respiratory failure
29
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
30
course of bronchiolitis
- worsens days 2-5 - avg course 10-12 days - 40% will wheeze again - very contagious
31
prevention of bronchiolitis
- hand hygiene | - vaccine ppx with synergis but very expensive, not used
32
pertussis
- aka whooping cough - d/t bortadella pertussis - tdap and dtap immunizations but needs booster
33
how is pertussis spread
- via respiratory droplets
34
stages of pertussis
- catarrhal - paroxysmal - convalescent
35
catarrhal stage of pertussis
- most contagious - can last 1-2 weeks - similar to cold sx
36
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
37
convalescent stage of pertussis
- may last for months | - paroxysms may return when pt suffers subsequent respiratory infx
38
sx that are assoc with paroxysms in pertussis
- respiratory distress - tongue protruding - face purple/ blue - eyes bulging, watering - posttussive emesis and exhaustion
39
dx of pertussis
- nasopharyngeal swab (takes days- weeks for results) | - high clinical suspicion
40
treatment of pertussis
- tx before results of swab - zithromax - supportive care
41
complications of pertussis
- usually none* - ear infection - loss of appetite - dehydration - pneumonia - rib fx - LOC - urinary incontinence - hernias - angina - encephalopathy or seizures from hypoxia
42
foreign body aspiration -> partial obstruction
- stridor
43
FB aspiration -> complete obstruction
- silence | - no airway -> no oxygenation -> no ventilation -> tissue death
44
when do most FB aspirations occur
- peak incidence 1-2 y/o | - 80% of episodes < 3 y/o
45
why do FBA occur in young kids
- small airway diameter - explore orally, dev fine motor skills - dont have molars to chew properly
46
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
47
what causes fatal aspirations
- balloons* - marbles - balls - toys - "anything strong, round, unbreakable"
48
where do FB lodge
- adults= R main stem bronchus | - kids= proximal bronchus, no predominance of R over L
49
when to suspect FBA
- chocking- witnessed event - wheezing - formerly speaking and now wont speak - coughing without URI sx
50
presentation of acute FBA
- usu presents within 24 hours of FBA - respiratory distress - cyanosis - AMS - can be life threatening
51
presentation of less acute FBA
- non-emergent - classic triad: - wheezing - decreased air entry esp regionally - cough
52
dx of FBA
- hx is key - xrays may be helpful - bronchoscopy- dx and FB removal
53
complications of FB removal
- dislodgement or breakage with adv into bronchioles or lungs - infx by prolonged FB - inflammation- may require steroid burst
54
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
55
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
56
clinical manifestations of RDS
- tachypnea - nasal flaring - grunting- expiratory - retractions - decreased breath sounds - pallor - diminished periph pulses - periph edema - poor urine output
57
dx of RDS
- clinical - CXR- testing can be lifesaving - ABG- hypoxia - hyponatremia from water retention
58
interventions to prevent RDS
- antenatal steroids - exogenous surfactant - assisted ventilation - thermoregulation - fluid mgmt - CV mgmt - nutritional support
59
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