Pediatric Patient Flashcards
Conditions that can predispose a child to respiratory failure (4)
- ↓ airway resistance (sm, compressible airway)
- Low functional residual capacity
- ↑ O2 metabolism → ↑ fatigue
- ↓ safe apnea time → precipitous hypoxia
Causes of inspiratory vs expiratory stridor.
Inspiratory = obstruction above glottis Expiratory = intrathoracic obstruction
*** Biphasic stridor = critical/fixed obstruction at any level
Proper positioning of child for imaging of neck/soft tissue?
Child’s head should be positioned in extension and film taken during inspiration.
Congenital lesions that may cause upper airway obstruction? (3)
- Choanal atresia - persistence of the bucconasal membrane in the posterior naris – bilateral causes acute resp distress when pt unable to breathe through nose while feeding. Unilateral presents when patent naris is obstructed by swelling/secretions.
- Macroglossia - abnormally lg tongue protrudes posteriorly into hypopharynx → obstruction with increased secretions, URI, etc
- Micrognathia - abnormally small mandible displaces normal-sized tongue (pierre-robin and treacher-collins syndroms). Obstruction worsens when supine.
Normal measurements of the retropharyngeal space?
Soft tissue width should not be larger than 6-7mm at C2, regardless of age.
At C6, should not exceed 14mm in children <15yo, 22mm in adults.
Retropharyngeal abscess –
Common organisms?
Management?
Most commonly polymicrobial. Strep and anaerobes are most commonly isolated. Consider MRSA in severe infections (jugular venous thrombosis or mediastinal extension)
IV abx - Clinda and 3rd gen cephalosporin.
Indications for surgical management: scalloping of the abscess wall, rim enhancement, lesions >2cm
Drooling, muffled hot-potato voice, trismus. Bulging/asymmetry of tonsils, Deviation of uvula (in 50% of pts).
Diagnosis?
Common organisms?
Treatment?
Peritonsillar abscess
Typically polymicrobial, predominant species S. pyogenes (GAS), S. aureus (incl MRSA), and respiratory anaerobes.
Abx alone are insufficient requires incision and drainage or needle aspiration.
Where is the carotid artery in relation to the tonsils?
Lies 25mm posterolateral to the tonsillar pillar in children >12yo
Preferred test for children <4yo for EBV?
EBV IgM Ab is preferred for infective mononucleosis (>90% sens), esp in children <4yo who are less likely to generate heterophile Ab iwith primary EBV infection.
Older children and adults: heterophile Ab in 50% w/in 1st week, 60-90% in weeks 2-3.
Adjunctive tx for infective mononucleosis?
Cautions in pediatric patients?
Steroids and racemic epinephrine to ↓ tonsillar edema.
*** Tx with glucocorticoids prior to diagnosis of leukemia → delayed diagnosis, ↑ risk of tumor lysis, complicate risk stratification, ultimately may cause fatal complications.
*** Exercise caution in using steroids in children/adolescents with any signs and symptoms of possible lymphoid malignancy.
Pt presenting with woody induration or brawny cellulitis of sublingual/submandibular/submaxillary spaces. Swelling is bilateral, without associated lymphadenopathy.
Diagnosis?
Treatment?
Ludwig’s angina
Tx: broad-spectrim abx with anaerobic coverage, airway support, admission.
Epiglottitis -
Common organisms?
Management?
H. influenzae type B - most common even with immunizations.
Others: H.flu (type A/F/non-typeable), strep, s. aureus (incl MRSA).
Pseudomonas and canddia if immunocompromised.
Non-infectious - thermal inury, steam inhalation, caustic ingestions, allergy, foreign body, irritants.
Tx: Younger children → secure airway in controlled setting.
Adolescents: IV abx, often do not require immediate airway management.
Abx: 2nd or 3rd gen cephalosporin.
Epinephrine dosing for anaphylaxis (IM and IV)
IM: 1mg/mL solution, 0.01 mg/kg up to 0.5mg/dose is initial management and may be repeated twice.
IV: 0.1mg/mL solution at 10mcg/kg bolus, followed by 0.1-1 mcg/kg/min up to 10mcg/min may be necessary for pts in shock.
Most common causes of chronic stridor in infants? (2)
- Laryngomalacia - incomplete development of cartilage of larynx, partial obstruction formed during inspiration → partial obstruction. Worse with supine position, neck flexion, ↑ resp effort (crying/URI). Most have complete resolution by 2yo.
- Vocal cord paralaysis - bilateral → severe resp and stridor, typically requires intervention for airway protection. Associated with CNS abnormalities (arnold-chiari). Unilateral usually L-sided related to traction on L recurrent laryngeal nerve at birth or compression from mediastinal structures. Unilateral → hoarse, weak cry, feeding difficulties, aspiration.
3-4yo presenting with hoarseness, abnormal cry, inspiratory stridor, progresses to severe respiratory distress.
Evaluation shows multiple lesions in larynx and/or vocal cords.
Diagnosis?
Laryngeal papilloma - most common benign laryngeal neoplasm in children, 2nd most common cause of hoarseness. Typically acquired 2/2 exposure to HPV via vertical transmission from infected mother.
