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Clinical Simulation > Pediatric Diseases > Flashcards

Pediatric Diseases Flashcards

1
Q

-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
A

Croup (Laryngotracheobronchitis)

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2
Q
  • Primarily a VIRAL infection

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

A

Etiology of Croup (Laryngotracheobronchitis)

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3
Q
  • 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
A

Primary assessment of Croup (Laryngotracheobronchitis)

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4
Q

Secondary assessment found in Croup (Laryngotracheobronchitis)

A

Lateral Neck X-ray

ABG

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5
Q
  • Haziness in the subglottic area, below the glottis
  • steeple point
  • pencil point
  • picket fence
  • hour glass narrowing of the upper airway
A

Lateral neck findings in Croup (Laryngotracheobronchitis)

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6
Q

Treatment and management of MILD cases of Croup (Laryngotracheobronchitis)

A
  • 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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7
Q

Drug Therapy - Croup

A
  • Racemic Epinephrine (MicroNefrin, Vaponefrin)

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

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8
Q

Treatment and management of SEVERE cases of Croup (Laryngotracheobronchitis)

A

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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9
Q

Criteria for intubation for Croup (Laryngotracheobronchitis)

A
  • Lethargic
  • Severe stridor at rest
  • Diminished breath sounds
  • Extreme accessory muscle usage
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10
Q

Criteria for extubation for Croup (Laryngotracheobronchitis)

A
  • Child condition is stable

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

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11
Q

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

A

Epiglottitis

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12
Q

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

A

Etiology of Epiglottitis

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13
Q
  • 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

A

Primary assessment of Epiglottitis

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14
Q
  • 2 to 6 years of age
  • Lifeless
  • Drooling
  • Hoarseness
  • Inspiratory stridor
  • Dysphagia
  • Tongue thrusts forward during -inspiration
  • Voice and cry muffled
  • Jaw jutted forward
A

Physical appearance found in Epiglottitis

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15
Q

Secondary assessment of Epiglottitis

A

Lateral neck x-ray
ABG
CBC

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16
Q
  • Haziness in the supraglottic area, supraglottic swelling above the glottic
  • Thumb sign
A

Lateral neck findings in Epiglottitis

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17
Q

CBC findings in Epiglottitis

A

Elevated WBC, bacterial infection

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18
Q

Treatment and management of Epiglottitis

A
  • 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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19
Q

Criteria for extubation - Epiglottitis

A
  • Childs condition is stable

- Swelling in the airway has diminished

20
Q

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

A

Primary assessment of Pediatric Poisoning/Toxic Substance Ingestion

21
Q

Secondary assessment of Pediatric Poisoning/Toxic Substance Ingestion

A
  • CXR
  • ABG
  • Electrolytes
  • Special tests
22
Q

Special tests for Pediatric Poisoning/Toxic Substance Ingestion

A
  • Information on the dose and type of poison ingested
  • Toxicology screening
  • Renal and liver function tests
  • Glucose level
  • Anion gap calculation
23
Q

Treatment and management for Pediatric Poisoning/Toxic Substance Ingestion

A
  • Supportive care
  • -stabilization of cardiovascular and respiratory systems
  • Decontamination
  • MV for ventilatory failure
  • Antidotes
  • -acetylcysteine for acetaminophen
  • -Narcan for narcotics
24
Q

)-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
A

Primary assessment in Cystic Fibrosis (Mucoviscidosis

25
Q

Secondary assessment for Cystic Fibrosis (Mucoviscidosis)

A
  • CXR
  • ABG
  • Pulmonary function
  • CBC
  • Sputum
  • Special tests
26
Q
  • Translucent (dark) lung fields
  • Depressed or flattened diaphragm
  • Right ventricular enlargement
  • Areas of atelectasis and fibrosis
A

CXR findings in Cystic Fibrosis (Mucoviscidosis)

27
Q

Pulmonary function findings in Cystic Fibrosis (Mucoviscidosis)

A

Decreased flow rates (obstructive disease)

28
Q

CBC findings in Cystic Fibrosis (Mucoviscidosis)

A

Elevated Hb and HCT

29
Q

Sputum culture findings in Cystic Fibrosis (Mucoviscidosis)

A
  • Common for:
  • Staphylococcus aureus
  • Haemophilus influenza
  • Pseudomonas
30
Q

Special tests - Cystic Fibrosis (Mucoviscidosis)

A
  • *Sweat chloride test: Chloride level >60 mEq/L
  • CFTR gene analysis (2 confirmed mutation)
  • Immunoreactive Trypsinogen test (IRT)
31
Q

Treatment and management of Cystic Fibrosis (Mucoviscidosis)

A
  • Airway clearance four times daily
  • Oxygen therapy
  • Aerosol therapy
  • Inhaled Antibiotics
32
Q

Airway clearance for Cystic Fibrosis (Mucoviscidosis)

A
  • Chest percussion and postural drainage
  • Exercise
  • PEP therapy
  • High frequency chest wall compression
  • Forced expiration techniques
33
Q

Aerosol therapy used for Cystic Fibrosis (Mucoviscidosis)

A
  • Bronchodilator
  • Mucolytics: Pulmozyme
  • Anti inflammatory: Advair, Flovent, Pulmicort
34
Q

Inhaled antibiotics used for Cystic Fibrosis (Mucoviscidosis)

A
  • Tobramycin
  • Colistin
  • Amikacin
35
Q

Drug Therapy - Cystic Fibrosis (Mucoviscidosis)

A
  • Aerosol therapy
  • Inhaled antibiotics
  • Digestive enzyme replacements
36
Q
  • Acute infection of the lower respiratory tract, usually caused by RSV.
  • Results in inflammation and obstruction of the small bronchi and bronchioles
A

Bronchiolitis

37
Q
  • 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
A

Primary assessment of Bronchiolitis

38
Q

Secondary assessment of Bronchiolitis

A
  • CXR

- ABG: Hypoxemia

39
Q

CXR - Bronchiolitis

A

Hyperinflation with areas of consolidation

40
Q

Special tests for Bronchiolitis

A

Antigen assay test conducted on swabs from oropharynx or nasopharynx

41
Q

Treatment and management for Bronchiolitis

A
  • 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
42
Q

Drug therapy for Bronchiolitis

A
  • Antibodies against RSV
  • Intravenous: RespiGam
  • Intramuscular: Synagic
  • Aerosol: Ribavirin give via SPAG
43
Q

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

A

Foreign Body Aspiration

44
Q
  • 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
A

Primary assessment of Foreign Body Aspiration

45
Q

Secondary assessment of Foreign Body Aspiration

A

CXR

46
Q
  • 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
A

CXR - Foreign Body Aspiration

47
Q

Treatment and management of Foreign Body Aspiration

A
  • Rigid bronchoscopy
  • Postural drainage and percussion
  • Aerosol therapy and bronchodilators

Clinical Simulation (7 decks)

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