Pediatrics Flashcards
Pulmonary distress in infants- name disorders
Neonatal RDS, Transient Tachypnea of newborn, and Persistent pulmonary HTN of the newborn
Who is most at risk for neonatal RDS?
Premature infants born less than 28 wks
Cause of neonatal RDS
Deficiency or inactivation of surfactant
Child born just a few minutes ago appearing blue with periods of not breathing. There is decreased urine output. Baby is in respiratory distress marked by grunting, nasal flaring, tachypnea, and shallow respirations. Diagnosis?
Neonatal RDS
Dx evaluation for neonatal RDS?
ABG for oxygen levels, CBC, CRP to r/o sepsis, Xray showing atelactasis and ground glass appearance, low lung volume
Tx for neonatal RDS
Supplemental oxygen, nasal CPAP, intubation for ventilation and surfactant- GENTLE. Surfactant can be given as prophylaxis in infants born at less than 27 weeks
Most likely complications of neonatal RDS
Due to therapeutic interventions, like invasive intubations. Chronic complication= bronchopulmonary dysplasia.
Prognosis of RDS
Worsens for 2-4 days after birth and slow improvement thereafter. If death occurs, most often between day 2-7.
Prevention for RDS
PREVENT PREMATURE BIRTH.
When are antenatal steroids given?
To pregnant women at risk of having preterm delivery
Most common CHRONIC childhood disorder
Asthma
What would make you suspicious of a child having asthma?
If family history, lower respiratory symptoms in 1st year of life such as coughing, wheezing triggered easily, and eczema in early months of life
2 year old child with eczema and 2 older sisters with asthma presents to you with wheezing, cyanosis, lethargy, tachycardia, dyspnea, cough, and diaphoresis. How would you diagnose this?
Young child- impulse oscillometry- passive technique to spirometry. If this is not helpful, trial with asthma medications and check for resolution of symptoms.
DDx for asthma
Cystic fibrosis- sweat chloride test to r/o. GERD- barium swallow to r/o.
Classifications of asthma in pediatric population
Intermittent- sx of wheezing and coughing 2 or less times a week, and 2 or less night episodes per month. Mild, moderate, persistent: Episodes of sx more than 2 times a week and more than 2 nighttime episodes per month
Classic triad of symptoms in FB aspiration
Wheezing, coughing, diminished breath sounds. May be complete, partial, or chronic obstruction. Complete will present with acute onset of choking, cyanosis, inability to cough or vocalize
Dx for FB aspiration
Rigid bronchoscopy
Tx for FB removal
Attempt removal with back blows and chest compressions in infants, heimlich maneuver in older children. Intubate until bronchoscopy can be performed. Nebulizers and chest physiotherapy after removal.
Epiglottitis causes
Infectious- H. infuenza B, staph, or strep. Non-infectious: thermal injury, FB or caustic ingestions, allergic reactions
7 year old boy presents with high fever, sore throat and in distress. He is drooling and is having difficulty eating with a “hot potato” voice. Appears toxic, with “sniffing” or “tripod” posture. How would you treat this?
Admit asap. Maintain patient airway. 3rd generation cephalosporings and antistaph agent active against MRSA, corticosteroids, supportive care.