- Racemic Epinephrine (MicroNefrin, Vaponefrin) - Corticosteriods for patients who don't respond to cool aerosol and racemic epinephrine

Pediatric Diseases Flashcards by Amy Yip

-Used to describe the inspiratory barking sound associated with the partial airway obstruction that develops in Croup (Laryngotracheobronchitis) subglottic croup.

LTB: an inflammatory process that causes edema and swelling of the mucous membrane just BELOW the vocal cords
-causes airway obstruction from tissue swelling

Croup (Laryngotracheobronchitis)

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Primarily a VIRAL infection

- Caused by Parainfluenza virus 1, 2, & 3, transmitted by aerosol droplet

Etiology of Croup (Laryngotracheobronchitis)

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Past medical history: recent cold that developed gradually into a barking cough over 2-3 days
Cough: barking, hoarse voice
Appearance of the chest: use of accessory muscles during inspiration, substernal and intercostal retractions
Respiratory pattern: tachypnea
Color
Breath sounds: diminished, inspiratory stridor
Physical appearance: age 6 months to 5 yrs, alert w/ some accessory muscle usage
Vital Signs: increased HR, BP, QT, low grade temperature

Primary assessment of Croup (Laryngotracheobronchitis)

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Secondary assessment found in Croup (Laryngotracheobronchitis)

Lateral Neck X-ray

ABG

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Haziness in the subglottic area, below the glottis
steeple point
pencil point
picket fence
hour glass narrowing of the upper airway

Lateral neck findings in Croup (Laryngotracheobronchitis)

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Treatment and management of MILD cases of Croup (Laryngotracheobronchitis)

Supportive care: temp control (cool environment), adequate hydration and humidification of inspired air
Oxygen therapy 30%-40%
Cool aerosol mist (face mask)
Drug therapy

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Drug Therapy - Croup

Racemic Epinephrine (MicroNefrin, Vaponefrin)

- Corticosteriods for patients who don’t respond to cool aerosol and racemic epinephrine

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Treatment and management of SEVERE cases of Croup (Laryngotracheobronchitis)

Child with SEVERE respiratory distress and or MARKED inspiratory stridor

Temperature control
Adequate hydration and humidification of inspired air
Transfer patient to ICU
Sedate patient if necessary
Place on T-piece or CPAP

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Criteria for intubation for Croup (Laryngotracheobronchitis)

Lethargic
Severe stridor at rest
Diminished breath sounds
Extreme accessory muscle usage

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Criteria for extubation for Croup (Laryngotracheobronchitis)

Child condition is stable

- Air leak around the tube (swelling has gone down)

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Emergency caused by inflammation of the suprglottic region that includes the epiglottis, aryepiglottic folds, and false vocal cords that causes swelling just ABOVE the vocal cords

Epiglottitis

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Bacterial infection cause by Haemophilus influenza B (gram negative) transmitted by aerosol droplets

Etiology of Epiglottitis

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Past medical history: sudden onset within 6-8 hrs
Cough: muffled cough
Appearance of chest
Respiratory pattern
Color
Breath sounds: diminished, inspiratory stridor
Physical appearance: 2-6 yrs old, lifeless, drooling, dysphagia, jaw jutted forward
Vital signs: high fever, increased HR, BP, QT

Diagnosis made at bedside

Primary assessment of Epiglottitis

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2 to 6 years of age
Lifeless
Drooling
Hoarseness
Inspiratory stridor
Dysphagia
Tongue thrusts forward during -inspiration
Voice and cry muffled
Jaw jutted forward

Physical appearance found in Epiglottitis

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Secondary assessment of Epiglottitis

Lateral neck x-ray
ABG
CBC

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Haziness in the supraglottic area, supraglottic swelling above the glottic
Thumb sign

Lateral neck findings in Epiglottitis

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CBC findings in Epiglottitis

Elevated WBC, bacterial infection

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Treatment and management of Epiglottitis

Immediate placement of an artificial airway
Transfer to ICU
Sedate if necessary
Place on T-piece or CPAP
Oxygen therapy
Drug therapy: Antibiotics

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Criteria for extubation - Epiglottitis

Childs condition is stable

- Swelling in the airway has diminished

Past medical history: history of ingestion
Color: pallor, cyanotic
Physical appearance
–varies according to substance
–pupillary reflex: dilated or constricted

Primary assessment of Pediatric Poisoning/Toxic Substance Ingestion

Secondary assessment of Pediatric Poisoning/Toxic Substance Ingestion

CXR
ABG
Electrolytes
Special tests

Special tests for Pediatric Poisoning/Toxic Substance Ingestion

Information on the dose and type of poison ingested
Toxicology screening
Renal and liver function tests
Glucose level
Anion gap calculation

Treatment and management for Pediatric Poisoning/Toxic Substance Ingestion

Supportive care
-stabilization of cardiovascular and respiratory systems
Decontamination
MV for ventilatory failure
Antidotes
-acetylcysteine for acetaminophen
-Narcan for narcotics

)-Past medical history; family history of CF

Shortness of breath: dyspnea on exertion
Cough: large amount of thick purulent secretions
Appearance of chest
Respiratory pattern
Color
Diagnostic chest percussion
Physical appearance: small for age, malnutrition, barrel chest
Vital signs

Primary assessment in Cystic Fibrosis (Mucoviscidosis

Secondary assessment for Cystic Fibrosis (Mucoviscidosis)

- CXR - ABG - Pulmonary function - CBC - Sputum - Special tests

- Translucent (dark) lung fields - Depressed or flattened diaphragm - Right ventricular enlargement - Areas of atelectasis and fibrosis

CXR findings in Cystic Fibrosis (Mucoviscidosis)

Pulmonary function findings in Cystic Fibrosis (Mucoviscidosis)

Decreased flow rates (obstructive disease)

CBC findings in Cystic Fibrosis (Mucoviscidosis)

Elevated Hb and HCT

Sputum culture findings in Cystic Fibrosis (Mucoviscidosis)

- Common for: - Staphylococcus aureus - Haemophilus influenza - Pseudomonas

Special tests - Cystic Fibrosis (Mucoviscidosis)

- *Sweat chloride test: Chloride level >60 mEq/L - CFTR gene analysis (2 confirmed mutation) - Immunoreactive Trypsinogen test (IRT)

Treatment and management of Cystic Fibrosis (Mucoviscidosis)

- Airway clearance four times daily - Oxygen therapy - Aerosol therapy - Inhaled Antibiotics

Airway clearance for Cystic Fibrosis (Mucoviscidosis)

- Chest percussion and postural drainage - Exercise - PEP therapy - High frequency chest wall compression - Forced expiration techniques

Aerosol therapy used for Cystic Fibrosis (Mucoviscidosis)

- Bronchodilator - Mucolytics: Pulmozyme - Anti inflammatory: Advair, Flovent, Pulmicort

Inhaled antibiotics used for Cystic Fibrosis (Mucoviscidosis)

- Tobramycin - Colistin - Amikacin

Drug Therapy - Cystic Fibrosis (Mucoviscidosis)

- Aerosol therapy - Inhaled antibiotics - Digestive enzyme replacements

- Acute infection of the lower respiratory tract, usually caused by RSV. - Results in inflammation and obstruction of the small bronchi and bronchioles

Bronchiolitis

- Past medical history: upper respiratory infection in a child age 3 months - 3 yrs - cough: intermittent - appearance of the chest: intercostal and substernal retractions - Respiratory pattern: tachypnea, apnea in severe cases - Breath sounds: wheezes, rhonchi, crackles - Physical appearance: Nasal discharge, lethargic, nasal flaring, cyanosis - Vital Signs: tachycardia, low grade fever, elevated BP

Primary assessment of Bronchiolitis

Secondary assessment of Bronchiolitis

- CXR | - ABG: Hypoxemia

CXR - Bronchiolitis

Hyperinflation with areas of consolidation

Special tests for Bronchiolitis

Antigen assay test conducted on swabs from oropharynx or nasopharynx

Treatment and management for Bronchiolitis

- Prophylaxis recommended for infants - Drug therapy - Most cases treated at home with humidification and oral decongestants - Severe cases (Patients with apnea) are hospitalized and treatment is directed at relieving the airway obstruction and hypoxemia

Drug therapy for Bronchiolitis

- Antibodies against RSV - Intravenous: RespiGam - Intramuscular: Synagic - Aerosol: Ribavirin give via SPAG

Sudden onset of airway obstruction caused by aspiration of a foreign object

Foreign Body Aspiration

- Past medical history: sudden onset, survey scene for pieces of food - SOB - Cough: violent - Respiratory pattern: retractions, tachypnea - Color: may be cyanotic - Breath sounds: varies, absent, rhonchi, wheezing, may be unilateral - Physical appearance: restless

Primary assessment of Foreign Body Aspiration

Secondary assessment of Foreign Body Aspiration

CXR

- Inspiratory and expiratory films indicate air trapping, hyperinflation and unequal ventilation. - Majority or items aspirated are radiolucent and can not be seen on a chest film

CXR - Foreign Body Aspiration

Treatment and management of Foreign Body Aspiration

- Rigid bronchoscopy - Postural drainage and percussion - Aerosol therapy and bronchodilators