Peds Lower Respiratory Flashcards
What is the supportive care for acute bronchitis?
Acute bronchitis—Increase fluid intake; avoid
expectorants, antihistamines, and cough
suppressants
What is the hall mark of acute bronchitis presentation?
Cough and wheezing. Lower airway obstruction, so has more problem getting air out than getting air in.
What are some of the conditions characterized by WHEEZING?
Asthma
Acute Bronchiolitis
Acute Bronchitis
Pneumonia (Viral origin)
Difference between bronchiolitis and bronchitis?
Bronchitis is a nonspecific inflammation of the
larger lower airways, associated with several childhood conditions; cough is usually part of the clinical picture
Bronchiolitis: An acute viral infection of the smaller airways; the most common serious acute respiratory illness of young children and infants; characterized by acute inflammation, edema, and necrosis of epithelial cells of the small airways, increased mucous production, and bronchospasm
Treatment for bronchiolitis
Supportive care and Prevention
a. Palivizumab (Synagis) is often used to prevent RSV infection in premature infants, younger than 2 years of age with chronic lung disease of prematurity, history of prematurity ( 35 weeks gestation), or congenital heart disease; Dose: 15 mg/kg IM, given in five monthly doses, beginning in November/December
b. Strict contact precautions (gown, gloves) in hospitalized children
c. Home measures—decrease exposure to contagious settings, avoid tobacco smoke exposure, and careful hand washing
What conditions cause stridor (5)
Croup (laryngotracheobronchitis) Foreign body (ER) congenital obstruction Peritonsillar abscess (ER) Acute epiglottittis. (ER)
Croup Physical findings
PhysicalFindings 1. Inspiratory stridor 2. Brassy, barky cough 3. Dyspnea; expiratory stridor if severe 4. Chest sounds are usually clear 5. Low-grade fever; may be high grade 6. Usually no involvement of lower respiratory tract
Croup definition
Definition: An acute inflammatory disease of the upper airway and larynx caused by a viral infection
Croup virus
Parainfluenza types 1,2,3
Adenovirus
Influenza virus
Croup severity
Mild disease—no dyspnea, hypoxia, or dehydration, barking cough, hoarse cry, no stridor at rest
Moderate disease—stridor at rest, dyspnea, mild retractions, hypoxemia, or dehydration
Severe disease: Significant stridor at rest, retractions are severe.
Croup severity treatment
Mild:
Supportive care: hydration, cool mist, antipyretics, single oral dose of dexamethasone
Moderate to severe disease:
a. Airway maintenance is the first priority
b. Hospitalize for supportive care, O2, medications, and IV fluids if indicated
Medications:
a. Nebulized epinephrine— observe for 3 hours after a dose for rebound respiratory distress
b. Corticosteroids will lessen the severity and duration of symptoms
- Oral dexamethasone
RSV is a common cause of: Bronchiolitis Common cold sinusitis Influenza
Bronchiolitis
Asthma Medication:
0-4 yrs old
Step 1 Intermittent Asthma
SABA Short acting beta agonist PRN: Albuterol
Asthma Medication:
0-4 yrs old
Step 2 Mild persistent Asthma
Low dose ICS: budesonide (pulmicort)
if not able to then, alternatives are
cromolyn or montelukast
Asthma Medication:
0-4 yrs old
Step 3 Moderate persistent
Medium dose ICS
Budesonide (pulmicort)
