Peds :( Flashcards
4 Ds of airway obstruction
Dyspnea
Drooling
Dysphagia
Distress
Laryngomalacia
Congenital disorder characterized by underdevelopment of cartilaginous support for supraglottic structures
Most common cause of persistent stridor in infants
Viral croup - Pathogenesis
Caused by parainfluenza viral serotypes causing inflammation of the entire airway; edema formation in the subglottic space causes obstruction
Viral croup - Presentation
Presents as URI prodrome followed by barking cough and stridor; fever is usually absent or low grade
Viral croup - Imaging
Neck radiograph shows subglottic narrowing (“steeple sign”)
Viral croup - Treatment
Mild group (barking cough w/o stridor at rest) indicates supportive therapy w/ oral hydration
Stridor at rest indicates intervention with nebulized epinephrine or glucocorticoids
Epiglottisitis - Pathogenesis
Bacterial infection of the airways, most often caused by H. influenzae; inflammation and swelling of the supraglottic structures (epiglottis and arytenoids) can lead to life-threatening upper airway obstruction
Epiglottisitis - Presentation
Sudden onset of high fever, dysphagia, drooling, inspiratory retractions, cyanosis, and stridor
Epiglottisitis - Treatment
Immediate endotracheal intubation to protect the airway
IV antibiotics - empiric to cover H. influenzae (Ceftriaxone)
Oral antibiotics to complete a 10-day course
Bacterial tracheitis (Pseudomembranous croup)
Bacterial infection of airway mucosa that occurs secondary to primary viral croup, resulting in inflammatory edema, purulent secretions, and pseudomembranes
Most often caused by S. aureus
Can be severe and life-threatening
Bacterial Tracheitis (Pseudomembranous croup) - Presentation & Treatment
Early presentation is similar to viral croup; however, instead of gradual improvement patients develop higher fever, toxicity, and severe upper airway obstruction
Risk of sudden respiratory arrest or progressive respiratory failure
Bacterial Tracheitis - Treatment
Endotracheal intubation
IV antibiotics to cover S. aureus
Presence of thick, purulent tracheal secretions may require debridement and suctioning
Bronchiolitis - Pathogenesis & Presentation
The most common serious acute respiratory illness in infants and young children, usually caused by RSV
Presents with 1-2 days of fever, rhinorrhea, and cough, followed by sheezing, tachypnea, and respiratory distress (shallow and rapid respirations)
Palivizumab
Monoclonal antibody prophylaxis against RSV for high-risk premature infants and those with chronic cardiopulmonary conditions
Asthma - Presentation & Treatment
Recurrent symptoms of cough, wheeze, SOB, chest tightness; usually with a specific trigger (illness, exercise, allergen)
Symptoms improved by bronchodilator (diagnostic)
Treatment with inhaled beta-agonist and inhaled corticosteroids
Acute bacterial / viral pneumonia
Presents with fever, tachypnea, cough; crackles and/or decreased breath sounds on auscultation
May occur with signs of infection at other sites (sinusitis, epiglottitis)
Empiric antibiotic therapy for suspected bacterial pneumonia
Infants - IV antibiotics for 4-12 weeks; most often Staph
3 months - 5 years - Oral amoxicillin; most often Strep pneumo
> 5 years - Oral amoxicillin or Azithromycin (for atypical Mycoplasma)
Cystic Fibrosis - Genetics
Single gene defect on chromosome 7 that encodes an epithelial chloride channel (CFTR)
Delta F508 is the most common mutation
Cystic Fibrosis - Diagnosis in newborns
Newborn screening by measuring immunoreactive trypsin (IRT), a pancreatic enzyme in blood; patients with CF have elevated IRT
Sweat chloride testing (>60mmol/L) is confirmatory
Cystic Fibrosis - Presentation in newborns
Meconium ileus
Failure to thrive
Frequent, foul-smelling, oily stools
Cough, wheezing, recurrent pneumonias, dyspnea, hemoptysis
Cystic fibrosis - Pathogenesis
Chronic airway infection with bacteria (S. aureus, H. influenzae) begins in the first few months of life; eventually, Pseudomonas becomes the predominant pathogen
Chronic infection leads to progressive airway and lung destruction (bronchiectasis) which causes failure of the muco-ciliary elevator and airflow obstruction
Cystic Fibrosis - Treatment
Pancreatic enzyme supplementation
High calorie/protein/fat/salt diet
Airway clearance therapy
Antibiotic treatment
Bronchopulmonary dysplasia - Pathogenesis
Premature lung makes insufficient surfactant, and premature antioxidant defense mechanisms do not protect lung from toxic oxygen metabolites
Results in early inflammation, hypercellularity, followed by healing with fibrosis
Infants require high pressure ventilization, resulting in a cycle of progressive lung injury
Bronchopulmonary dysplasia - Treatment
Surfactant replacement therapy
Supportive (mechanical ventilation)
