Pediatric Diseases Flashcards
-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)
- Primarily a VIRAL infection
- Caused by Parainfluenza virus 1, 2, & 3, transmitted by aerosol droplet
Etiology of Croup (Laryngotracheobronchitis)
- 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)
Secondary assessment found in Croup (Laryngotracheobronchitis)
Lateral Neck X-ray
ABG
- 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)
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
Drug Therapy - Croup
- Racemic Epinephrine (MicroNefrin, Vaponefrin)
- Corticosteriods for patients who don’t respond to cool aerosol and racemic epinephrine
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
Criteria for intubation for Croup (Laryngotracheobronchitis)
- Lethargic
- Severe stridor at rest
- Diminished breath sounds
- Extreme accessory muscle usage
Criteria for extubation for Croup (Laryngotracheobronchitis)
- Child condition is stable
- Air leak around the tube (swelling has gone down)
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
Bacterial infection cause by Haemophilus influenza B (gram negative) transmitted by aerosol droplets
Etiology of Epiglottitis
- 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
- 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
Secondary assessment of Epiglottitis
Lateral neck x-ray
ABG
CBC
- Haziness in the supraglottic area, supraglottic swelling above the glottic
- Thumb sign
Lateral neck findings in Epiglottitis
CBC findings in Epiglottitis
Elevated WBC, bacterial infection
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
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
