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EM200 > Pediatric Resp > Flashcards

Pediatric Resp Flashcards

1
Q

Common resp illnesses in kids:

A

Croup

Asthma
Bronchiolitis
Pneumonia
Foreign body aspiration

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2
Q

Upper airway symptoms:

A

Stridor

Supraclavicular and suprasternal retractions

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3
Q

Lower airway symptoms:

A

Wheezing

Subcostal and intercostal retractions

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4
Q

Important features of physical exam in resp peds emergencies:

A

General appearance
Level of activity

speaking/crying

Vital signs
Work of breathing
Lung exam
Hydration/circulation

Mental status

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5
Q

The 5th vital sign =

A

Pulse ox

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6
Q

Normal SpO2 in kids

A

Over 95%

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7
Q

Sensitivity of spO2 in predicting outcomes

A

Not sensitive

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8
Q

Respiratory Emergencies:

Differential Diagnosis

A

Croup

Rings and slings
GE reflux
Pulmonary disease

Asthma

Bronchiolitis

Foreign body aspiration

Cystic Fibrosis

Anaphylaxis

Pneumonia
Cardiac disease

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9
Q

15 mos healthy male
Acute onset of barky cough/gasping Awoke from sleep
1 day of rhinorrhea
Crying, upset with hoarse voice
Inspiratory stridor
Clear lungs

Diagnosis?

A

Croup

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10
Q

Croup:

  1. Aka?
  2. Ages?
  3. Etiology / Organisms?
  4. Most common etiology?
A
  1. Laryngotracheobronchitis
  2. Age 6 mos-3 yrs
  3. Always VIRAL etiology (RIPAM)
    • RSV
    • Influenza
    • Parainfluenza
    • Adenovirus
    • Measles
  4. Parainfluenza
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11
Q

Pathophysiology of Croup:

A

Invasion of pharyngeal epithelium

Spread to larynx
Mucous production and edema
Subglottic larynx and vocal cord involvement

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12
Q

Croup:

History?

A

Preceeding URI symptoms
Fever
Abrupt onset of barking cough Distress with crying/agitation

Improvement on way to ED

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13
Q

Croup:

Physical Exam

A

Mild to moderately ill, nontoxic

Rarely cyanotic or hypoxemic
WOB
Inspiratory stridor

Barky, seal-like cough

Lungs clear

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14
Q

Croup:

Radiology

A

Rule out other dx
Subglottic narrowing

Steeple sign

Remember, croup is a clinical diagnosis!

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15
Q

Croup:

Labs?

A

Generally not useful
CBC with leukocytosis

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16
Q

Croup:

Differential Diagnosis?

A

Foreign body aspiration/obstruction

Viral URI

Tracheitis

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17
Q

Croup:

Therapy?

A

Cool mist/hot shower

Dexamethasone 0.6mg/kg (8mg) - PO or IM

Racemic Epinephrine – nebulized (if there is an audible stridor at rest)

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18
Q

Croup:

Disposition vs admit?

A

Majority outpatient management

Admission if there is…

  • Questionable diagnosis
  • Continued audible stridor
  • Toxic appearance
  • Dehydration and vomiting
  • Very young (<3 mos?)
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19
Q

Seven year old with cough/SOB

History of wheezing in the past

Breathless; one-word answers

Sitting forward

Inspiratory & expiratory wheezes

Subcostal & intercostal retractions

What is the diagnosis?

A

Asthma

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20
Q

Asthma:

Pathophysiology?

A
  • 1) Airway hyperresponsiveness
    • Muscle constriction, edema, mucous production
    • “Late phase” reaction at 4-12 hours - inflammatory cells and mediator
    • Air trapping –> dead space ventilation –> V/Q mismatching
  • 2) Chronic inflammation
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21
Q

Respiratory / Electrolyte side effects of asthma:

A
  • Hypoxemia
  • Hypercapnea & respiratory acidosis
  • Metabolic acidosis
    • Increased oxygen demand
    • Increased energy consumption
  • Respiratory failure
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22
Q

Parts of patient history with asthma to obtain:

A

A brief focused history + Comprehensive history

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23
Q

Parts of the brief focused history for asthma:

A

Duration of symptoms

Severity of symptoms

Current medication use

Hx of severe exacerbations

Signs, symptoms of infection

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24
Q

Parts of the comprehensive history for asthma:

A

Triggers

Possible foreign body aspiration

Activity level

Oral intake

ROS

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25
Q

Asthma:

Risk Factors for Severe Exacerbations and Mortality

A

History of sudden, severe attacks

Prior intubation, ICU admission

Two or more hospitalizations in the last year

Three or more ED visits in the last month

Hospitalization in the last month

Current or recent use of systemic steroids

Medical comorbidity

Psychosocial problems

Age less than five years

26
Q

How RR, retractions, and whezing change in mild, moderate, and severe cases of asthma:

A

RR: Increased –> further increased –> increased or decreased

Retractions: None/mild –> moderate –> severe

Wheezing: Moderate/End-expiratory –> loud throughout exhalation –> inspiratory and expiratory

27
Q

Radiological imaging for Athma:

  1. radiological signs of asthma?
  2. Indications for radiological imaging?
A
  1. Hyperinflation, Peribronchial thickening, Atelectasis
  2. Focal exam, Minimal improvement, Chest Pain, Severe exacerbations, First time wheezing
28
Q

Labs needed for asthma

29
Q

Differential dx for asthma?

A

Anaphylaxis

Foreign body aspiration

Bronchiolitis

Rings and slings

Gastroesophageal reflux

Cardiac disease

30
Q

Therapy for asthma?

A
  • Albuterol (nebulized if severe, puffs if not)
  • Ipratropium (anticholinergic bronchodilator–less potent than albuterol–always used in conjuction with albuterol)
  • Corticosteroids
  • MgSO4
  • Parenteral ß-agonists (epinephrine or terbutaline)
31
Q

Side effects of albuterol:

A

Tachycardia

Hypokalemia

32
Q

When asthma patient needs to be admitted:

A

O2 requirement

Persistent respiratory distress (Need for treatments < Q4 hours)

Air leak

Underlying high risk factors ED visit last 24 hours

33
Q

Instructions to parents if the asthma patient is D/Ced home:

A

Observe 60-90 min after last treatment

“Action Plan”

STEROIDS

  • Oral 2 mg/kg per day for 4 days
  • Inhaled corticosteroids?

Educate

Follow-up with primary doctor

34
Q

Seven-week-old infant presents with fever, decreased PO, and fast breathing

Cold symptoms for a few days - now has developed these other symptoms

Former 31-week premie

Diffuse wheezing and retractions on exam.

Most likely diagnosis?

A

Bronchiolitis

35
Q
  1. Typical Pathophysiology of Bronchiolitis?
  2. Other viral causes?
  3. Bacteria?
  4. Season?
  5. Peak age?
  6. Oldest age?
A
  1. Usually due to RSV (85% of cases)
  2. Other viruses (RIPAM)
  3. Mycoplasma
  4. Winter and early spring
  5. Peak incidence in 2-8 month olds
  6. May be seen up to 2y/o
36
Q

What is the patho process of bronchiolitis?

A

RSV invades nasopharyngeal epithelium

Cell to cell transfer to lower airways

Cell death and sloughing

Mucous production

Airways edema and mucous plugging

37
Q

Role of airway hyperresponsiveness in bronchiolotis?

In which patients does apnea occur?

A

Minor role for hyper-respons

Apnea only seen in infants less than 1m

38
Q

Presentation of bronchiolitis patients?

Questions you should ask about in HPI?

A

Begins as URI; +/- fever
Progression over 2-5 days

Ask about:

  • Activity level
  • Ability to feed
  • Hydration status (urine output) Apnea or cyanosis
39
Q

Risk factors for developing severe bronchiolitis:

A

Prematurity (<35 weeks GA)

Bronchopulmonary dysplasia

Heart disease

Immunodeficiency

Young age (< 3 months)

40
Q

Physical findings of bronchiolitis:

A

Grunting

Nasal flaring Retractions

Lung exam

Wheezing

Crackles

Decreased aeration

Exam changes often

41
Q

Radiological findings of bronchiolitis:

A

Hyperinflation

Peribronchial thickening

Atelectasis

42
Q

Bronchiolitis labs

A

Rapid antigen

Resp Cx

If febrile + <3m –> Urine cx + Blood Cx + Sepsis w/u

43
Q

Treatment of bronchiolitis:

A
  • Supportive Care:
    • Oxygen as needed
    • Hydration - IVF’s as needed Close monitoring
    • Nasal suctioning
    • Pulmonary toilet
    • Ventilatory support
  • Bronchodilators:
    • Albuterol
    • Racemic Epinephrine
  • Corticosteroids
    • Only if older child and if there is concurrent asthma
44
Q

D/C instructions for bronchiolitis:

A

Encourage hydration

Acetaminophen

Bronchodilators if patient improves with bronchodilator use in the ED

Close follow-up

45
Q

Twenty-six month old boy with complaints of fever, vomiting, RLQ abdominal pain

Symptoms since yesterday afternoon

Immunizations UTD

T 38.9oC HR 138 RR 48

Lungs clear, no retractions

Diffuse abdominal pain, rebound in RLQ

Most likely dx?

46
Q

Etiology of pneumonia in neonates:

A

Group B Strep

GN enterics

47
Q

Etiology of pneumonia in 2wk to 2 month olds?

A

Chlamydia trachomatis

Viruses

S. pneumo

A. aureus

H. flu

48
Q

Etiology of pneumonia in 2mo - 3 yo>

A

Viruses

S. pneumo

S. aureus

H flu

49
Q

Pneumonia etiology in 3-19 yo?

A

Viruses

S. pneumoniae

Mycoplasma pneumoniae

50
Q

Pathophys of pneumonia

A

Organisms reach the lung by aspiration or hematogenous route

Inflammatory reaction with exudation of fluid and PMN’s

Fibrin deposition; macrophage invasion

Accumulation of fluid in lobe gives lobar pattern on x-ray

Effusions and/or empyema may occur

51
Q

Cause of UQ abd pain in pneumonia?

A

T9 dermatome distribution shared by lung and abdomen

52
Q

Referred pain seen in pneumonia?

A

Abd complaints

Neck pain and meningismus if of the upper lobes

Back pain

53
Q

Radiological features of more severe pneumonia

A

Bilateral involvement

Pleural effusion

Pneumatocele

54
Q

Pneumonia labs:

  1. Pneumococcus associated with this lab finding:
  2. How common blood culture has organism?
  3. Lab ot collect if there is severe disease?
A
  1. Marked leukocytosis
  2. Rarely
  3. ABGs
55
Q

Antitussives in pneumonia

A

Not indicated

56
Q

20-month old boy found coughing

Later that day, fast breathing

Afebrile, no URI symptoms

Active, playful

RR 42

Mild right-sided wheezes and decreased breath sounds

Most likely dx?

A

Foreign body asp

57
Q

Foreign body much more common on which side?

A

only slightly more common on the right

58
Q

Missed dx of foreign body may lead to:

59
Q

Radiological findings of foreign body aspiration:

A

Hyperinflation

Infiltrates

Foreign body

60
Q

Tx for foreign body asp?

A

ENT consult –> bronchoscopy

EM200 (15 decks)

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