PEDS mod 6 Flashcards
SIDS is only unexplained after
Complete autopsy • Examination of death scene • Review of clinical history
- Maybe assoc with congenital heart disease, neuromuscular disorders, primary ciliary dyskinesia
Pectus excavatum
Normal <25 seconds
High elevation
Prematurity
Genetic/neuro disorders
CSA
- Less effective than nasal corticosteroid
- Take at night
- equal in effectiveness to cromolyn
2nd gen “new” less drowsy (cetirizine, fexofenadine, loratadine)
- works well but not 1st line
Ipatropium bromide
Corticosteroid nasal spray
Fluticasone
Decongestant:
pseudoephedrine
- mast cell stabilizer
Cromolyn
- Episodic symptoms of airflow obstruction are present
- Airflow obstruction or symptoms are at least partially reversible
- Alternative diagnoses are excluded
Asthma Dx
What is the most common underlying diagnosis in children with pneumonia?
Asthma
· +- breathless after physical activity such as walking
· Can talk in sentences and lie down
· +- be agitated
Mild acute
· Breathless while talking
· Infants have feeding difficulties and a softer, shorter cry
Moderate to severe asthma
· Breathless during rest
· Not interested in feeding
· Sit upright
· Talk in words (not sentences)
· Usually agitated.
Severe
· Drowsy and confused
Adolescents +- drowsy/confused until they are in frank respiratory failure
Imminent respiratory arrest
(acute severe asthmatic episode that is resistant to appropriate outpatient therapy):
- Medical emergency that requires aggressive inpatient management
- ICU for the treatment of hypoxia, hypercarbia, and dehydration and possibly for assisted ventilation because of respiratory failure
Status asthmaticus
- Conjunctival congestion/inflammation
- Allergic shiners
- Nose crease
- Pale violaceous/blue nasal mucosa
Signs of atopy or allergic rhinitis
- Accessory muscles of respiration are not used
- The heart rate is less than 100 beats per minute
- Pulsus paradoxus is not present
- Auscultation of chest reveals moderate wheezing, which is often end expiratory
- Oxyhemoglobin saturation with room air is greater than 95%
Mild acute asthma episode
- Accessory muscles of respiration typically are used
- Suprasternal retractions are present
- The heart rate is 100-120 beats per minute
- Loud expiratory wheezing can be heard
- Pulsus paradoxus may be present (10-20 mm Hg)
- Oxyhemoglobin saturation with room air is 91-95%
Moderately severe asthma
- The respiratory rate is often greater than 30 breaths per minute
- The heart rate is greater than 120 beats per minute
- Loud biphasic (expiratory and inspiratory) wheezing can be heard
- Pulsus paradoxus is often present (20-40 mm Hg)
- Oxyhemoglobin saturation with room air is less than 91%.
Severe asthma episode
- Paradoxical thoracoabdominal movement
- Wheezing may be absent (in patients with the most severe airway obstruction)
- Severe hypoxemia may manifest as bradycardia
- Pulsus paradoxus may disappear; this finding suggests respiratory muscle fatigue
Status asthmaticus with often imminent respiratory arrest:
· Tracheobronchomalacia
· Hyperventilation syndrome
· Vocal cord dysfunction
· Pulmonary edema
· Collagen vascular disease
· Reactive airway disease
Other problems that can come from asthma
· Spirometry: essential objective measure for establishing the diagnosis of asthma
· +-Eosinophil counts and IgE levels
· +-Bronchial provocation tests (specialized test)
Eval for asthma
Pulmonary function testing: not reliable under what age?
<5
· (3-6 y) and older children who are unable to perform the conventional spirometry:
Impulse oscillometry system
· Normal forced vital capacity (FVC)
· Reduced forced expiratory volume in 1 second (FEV1)
· Reduced forced expiratory flow more than 25-75% of the FVC (FEF 25-75)
Typical findings of asthma
Does a normal peak flow rate necessarily mean a lack of airway obstruction?
No
o F/u q 2-6 wks until controlled; q 1-6 mo thereafter
Asthma follow up
montelukast (Singulair)
Mast cell stabilizer
