Pediatric Lung and Airway Topics Flashcards
Grunt Implies
Decreased compliance of chest wall
Trying to create PEEP
What is Stridor
Turbulent inspiratory airflow below/in the larynx coming across a partly closed glottis
What is Stertor?
Snoring
When are ronchi/crackles heard? What do they mean?
Inspiration.
Fine = Acute inflammation
Harsh = Fibrosis
When are rales/wheezes heard? What do they mean?
Expiratory
Obstruction
Physical signs of a lung/airway problem in a peds patient
Tachypnea, nasal flaring, intercostal retractions, accessory muscle use, pursed lips, prolonged expiratory phase, cyanosis
Wheeze vs. Stridor. Who is intra and who is extrathoracic?
Wheeze – Intrathoracic, Worse on expiration
Stridor – Extrathoracic, worse on inspiration
Example of fixed obstruction
Laryngeal or tracheal web
incomplete recanalizaton of the larynx
Variable extrathoracic problems in peds patients
Vocal Cord Dysfunction
Obstructive Sleep Apnea
Variable intrathoracic obstruction problems in peds patients
Endobronchial or tracheal tumor
Causes of bronchiolitis
RSV, hMPV,
Influenza, Parainfluenza,
Corona, Rhino, Adeno
When does bronchiolitis hit the midwest?
Nov-April
Who gets bronchiolitis?
Nearly all kids by age 2
Risk of 2ndary bacterial infection or otitis media
Big risks with bronchiolitis?
High risk for infants with poor lung development
Can cause apnea in infants
Treatment for bronchiolitis?
Supportive (Oxy., Fluids)
Prevention with Palivizumab monthly during season
Presentation of bronchiolitis?
Runny Nose, Cough, Fever, tachypnea,
Intercostal retractions
Bilateral wheezing and crackles
Diffuse infiltrates
What is a steeple sign on an X ray telling you?
Epiglottal Swelling, Narrowing of Airway
Fancy word for croup
laryngotracheitis
Symptoms of Croup
Seal-bark cough, Hoarseness, Stridor
Subglottic larynx edema/inflam.
Which kids get croup?
6%, peak at 1-2 yo
Slightly more males (1.5:1)
When do kids get croup?
Late fall, early winter
Causes of croup?
Parainfluenza, RSV
Influenza, Coxsackie, rhino, mPNV
Signs of H. flu
Unable to control secretions, fever, unimmunized, tripod position, elevated RR, thumb sign on epiglottis x ray
How many ribs should you see on a chest xray
10
Who has the membrane
diptheria
What does the trachea move toward and away from
Away from infection
Toward collapse
Most common causes of CAP in an under 1 month
Group B
E coli
L monocytogenes
CMV, HSV
Most common causes of CAP in an 1-3 months
Virus
S pneumo
S aureus
afebrile pneumonitis pathogens
Most common causes of CAP in a 3 month-5 years
Virus
S pneumo
S aureus
Most common causes of CAP in school age
Virus
M pneumoniae
S pneumoniae
C pneumoniae
Tests encouraged in evaluating an outpatient peds pneumonia?
Pulse Ox Flu testing (if in season) Mycoplasma IgM (before giving a macrolide)
Which test aren’t encouraged, but could be fine in an outpatient peds pneumonia
CXR
Blood Culture if deterioration or no improvement
4 month old. stridor of upper airways. Noisy breathing since week 2 of life. No recent illness, fevers, or coughs. What is it
Laryngomalacia
What do you do for Laryngomalacia patients?
Surgery to remove redundant tissues
Describe how diaphragmatic hernia patient might present
Newborn in resp. distress.
Grunting, tachypneic, cyanotic even w/ bag valve
Crackles on right, no sounds on left
What does diaphragmatic hernia do to the lungs?
Causes lung hypoplasia, persistent pulmonary hypertension
How is diaphragmatic hernia treated?
Medically managed with ventilatory support or ECMO
Surgical management when stable
