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clin med IV > pedi pulm > Flashcards

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
Q

PE findings for bronchiolitis

A
  • fever of 102
  • tachycardia/ tachypnea
  • respir distress
  • HEENT normal except rhinorrhea
  • wheezing lungs*
  • if decreased breath sounds- impending doom
  • normal O2 or hypoxic
26
Q

dx of bronchiolitis

A
  • CXR if first episode of wheezing or considering pneumonia

- PCR for RSV with nasal washing

27
Q

tx of bronchiolitis as outpatient

A
  • supportive care
  • fluids
  • tylenol, motrin
  • edu to return if worening or respiratory distress
28
Q

tx of bronchiolitis as inpatient

A
  • O2 support
  • consider CPAP or high flow O2
  • no chest PT
  • intubation if impending respiratory failure
29
Q

who should be admitted for bronchiolitis

A
  • 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
Q

course of bronchiolitis

A
  • worsens days 2-5
  • avg course 10-12 days
  • 40% will wheeze again
  • very contagious
31
Q

prevention of bronchiolitis

A
  • hand hygiene

- vaccine ppx with synergis but very expensive, not used

32
Q

pertussis

A
  • aka whooping cough
  • d/t bortadella pertussis
  • tdap and dtap immunizations but needs booster
33
Q

how is pertussis spread

A
  • via respiratory droplets
34
Q

stages of pertussis

A
  • catarrhal
  • paroxysmal
  • convalescent
35
Q

catarrhal stage of pertussis

A
  • most contagious
  • can last 1-2 weeks
  • similar to cold sx
36
Q

paroxysmal stage of pertussis

A
  • 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
Q

convalescent stage of pertussis

A
  • may last for months

- paroxysms may return when pt suffers subsequent respiratory infx

38
Q

sx that are assoc with paroxysms in pertussis

A
  • respiratory distress
  • tongue protruding
  • face purple/ blue
  • eyes bulging, watering
  • posttussive emesis and exhaustion
39
Q

dx of pertussis

A
  • nasopharyngeal swab (takes days- weeks for results)

- high clinical suspicion

40
Q

treatment of pertussis

A
  • tx before results of swab
  • zithromax
  • supportive care
41
Q

complications of pertussis

A
  • usually none*
  • ear infection
  • loss of appetite
  • dehydration
  • pneumonia
  • rib fx
  • LOC
  • urinary incontinence
  • hernias
  • angina
  • encephalopathy or seizures from hypoxia
42
Q

foreign body aspiration -> partial obstruction

A
  • stridor
43
Q

FB aspiration -> complete obstruction

A
  • silence

- no airway -> no oxygenation -> no ventilation -> tissue death

44
Q

when do most FB aspirations occur

A
  • peak incidence 1-2 y/o

- 80% of episodes < 3 y/o

45
Q

why do FBA occur in young kids

A
  • small airway diameter
  • explore orally, dev fine motor skills
  • dont have molars to chew properly
46
Q

what do kids aspirate

A
  • 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
Q

what causes fatal aspirations

A
  • balloons*
  • marbles
  • balls
  • toys
  • “anything strong, round, unbreakable”
48
Q

where do FB lodge

A
  • adults= R main stem bronchus

- kids= proximal bronchus, no predominance of R over L

49
Q

when to suspect FBA

A
  • chocking- witnessed event
  • wheezing
  • formerly speaking and now wont speak
  • coughing without URI sx
50
Q

presentation of acute FBA

A
  • usu presents within 24 hours of FBA
  • respiratory distress
  • cyanosis
  • AMS
  • can be life threatening
51
Q

presentation of less acute FBA

A
  • non-emergent
  • classic triad:
  • wheezing
  • decreased air entry esp regionally
  • cough
52
Q

dx of FBA

A
  • hx is key
  • xrays may be helpful
  • bronchoscopy- dx and FB removal
53
Q

complications of FB removal

A
  • dislodgement or breakage with adv into bronchioles or lungs
  • infx by prolonged FB
  • inflammation- may require steroid burst
54
Q

respiratory distress syndrome (RDS)

A
  • 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
Q

etiology of RDS

A
  • 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
Q

clinical manifestations of RDS

A
  • tachypnea
  • nasal flaring
  • grunting- expiratory
  • retractions
  • decreased breath sounds
  • pallor
  • diminished periph pulses
  • periph edema
  • poor urine output
57
Q

dx of RDS

A
  • clinical
  • CXR- testing can be lifesaving
  • ABG- hypoxia
  • hyponatremia from water retention
58
Q

interventions to prevent RDS

A
  • antenatal steroids
  • exogenous surfactant
  • assisted ventilation
  • thermoregulation
  • fluid mgmt
  • CV mgmt
  • nutritional support
59
Q

how is exogenous surfactant delivered for RDS

A
  • given to preterm infants < 30 weeks with respiratory distress, apnea, fail cpap
  • admin via endotracheal tube within 30-60 min of life

clin med IV (23 decks)

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