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Clin Med Peds > Peds Pulmonary 1 > Flashcards

Peds Pulmonary 1 Flashcards

1
Q

definition of acute epiglottitis

A

acute inflammation in the supraglottic region (top of the airway)

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2
Q

is epiglottitis an emergency?

A

YES!!! it’s a medical emergency

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3
Q

who gets epiglottitis?

A

kids <6 months y/o

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4
Q

why are kids <6 months y/o at risk for epiglottitis?

A

b/c they aren’t fully immunized

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5
Q

what 3 organisms cause epiglottitis?

A

(1) Strep pyogenes (also causes strep)
(2) Strep pneumonia
(3) Staph

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6
Q

clinical presentation of epiglottitis?

A

Rapid onset of sx’s w/in hours
-patient has mile sore throat and fever -> TOXIC appearance

  • drooling
  • labored breathing (STRIDOR)
  • TRIPODDING
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7
Q

breath sounds for epiglottitis?

A

stridor (b/c airway is partially obstructed)

stridor is a LATE FINDING

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8
Q

what’s the tripod position look like?

A

KID IS TRYING TO PULL THEIR AIRWAY OPEN

  • neck hyperextended
  • mouth open
  • chin up-sniffing
  • leaning forward
  • outstretched arms
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9
Q

as epiglottitis worsens, what’s the appearance of the kid?

A

TOXIC APPEARANCE

  • air hunger
  • stridor is a LAYE FINDING
  • restlessness
  • pre apnea -> coma -> death
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10
Q

dx of epiglottitis

A

clinical suspicion

CALL ANESTHESIA (don’t wait to do lateral neck film)

NEED DIRECT VISUALIZATION WITH INTUBATION AND ENDOSCOPY

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11
Q

if do lateral neck film on pt with epiglottitis, what sign to do you see on the film?

A

thumb print sign

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12
Q

if in the office and pt comes in with epiglottitis, what do you do?

A
  • call the ED and simultaneously have someone calling EMS
  • ED will have anesthesia standing by
  • EMS needs paramedic support URGENTLY
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13
Q

if in the ED and pt comes in with epiglottitis, what do you do?

A

Anesthesia STAT to intubate

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14
Q

while you are waiting for intervention on epiglottitis pt what should you be doing for the patient?

A
  • keeping the patient calm and quiet and seated in comfortable position
  • use O2 if child tolerates it
  • establish 2 lines if child tolerates it
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15
Q

what IV antibiotics are used for epiglottitis tx?

A

Ceftriaxone or Cefotaxime x7-10 days (to cover for staph or strep)

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16
Q

is epiglottitis contagious or not contagious?

A

NOT CONTAGIOUS (but can get strep if pt has epiglottitis d/t strep)

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17
Q

if unimmunized or immunosuppressed family contacts or child <6 months w/out HIB vaccine complete and family member has epiglottitis, what’s the tx?

A

Rifampin for ppx

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18
Q

what are the breath sounds for croup?

A

seal barking cough and stridor

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19
Q

what is croup?

A

inflammation of the larynx, trachea (subglottic area - still the upper airway)

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20
Q

what’s the etiology of croup?

A

viral

-Parainfluenza 1, 2, 3

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21
Q

who gets croup?

A

age 3 months-5 y/o (peak age of 2 y/o)

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22
Q

what seasons is croup seen and at what times?

A

seen in Fall and Spring

time: b/w 10pm and 4am
- child has URI earlier in day, then at 10pm wakes everyone up with their barking cough

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23
Q

clinical presentation of croup

A
  • URI sx’s: day 0-2

- Barking cough (expiratory sound) on days 0-5

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24
Q

when does croup worsen?

A

on days 2 and 3 of the barking cough

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25
Q

how many days does it take croup to resolve?

A

5-7 days

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26
Q

what’s the general PE for croup like?

A

kids won’t be able to find comfortable position, crying with coughing, restless, clingy

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27
Q

what’s the lung PE for croup like?

A

NORMAL LUNG SOUNDS B/C NOT A LUNG ISSUE

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28
Q

dx of croup

A

clinical dx

maybe do rapid strep if sore throat (strep can occur with croup)

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29
Q

when do you do x-ray for croup?

A

you don’t unless you are concerned about a foreign body

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30
Q

outpatient tx for mild-moderate croup w/NO STRIDOR

A

Decadron (dexamethasone) IV solution given PO - 0.6mg/kg to a max of 10mg

HOME if comfortable
Lasts 24-72hrs
Remind family this gets worse day 2 and 3

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31
Q

if patient with croup and stridor, where do they belong?

A

in the ED

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32
Q

tx for moderate-severe croup w/STRIDOR

A

Decadron IV solution given PO

Racemic EPI by nebulizer (duration of action is 2hrs) - repeat as/if needed

watch 2-3 hours for re-occurrence

if recurrence: consider admission

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33
Q

if pt with moderate-severe croup w/STRIDOR has no improvement, what is the tx?

A

consider continuous racemic after second, IM epi, and consider transfer to PICU

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34
Q

what does the RACEMIC EPI by nebulizer do for tx of croup?

A

opens up the upper airway

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35
Q

tx for mild croup?

A

treat at home

  • ***cold night air (open the window)
  • humidfied air
  • open freezer door
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36
Q

croup prognosis?

A

excellent prognosis

usually self resolving w/in 4-7 days of onset

37
Q

bacterial tracheitis is a ____ condition

A

emergent condition

38
Q

what is bacterial tracheitis?

A

bacterial infection of the trachea that can cause complete respiratory failure by blockage of the trachea with swelling and purulent drainage

39
Q

bacterial tracheitis is a rare complication of…

A

croup

40
Q

what is bronchiolitis?

A

inflammation of the bronchioles (b/w the bronchi and the alveoli)

bronchioles = lower respiratory tract

41
Q

what do you get in the bronchioles in bronchiolitis/

A

a lot of mucus

42
Q

who gets bronchiolitis?

A

kids < 2 y/o (b/c have very small bronchioles)

43
Q

bronchiolitis is more common in…

A

boys, non-breast fed babies, babies born to moms who smoke

44
Q

what kids with bronchiolitis are at a greater risk for morbidity/mortality?

A

kids with underlying cardiopulmonary disease (premies, asthmatics, immune compromised patients)

kids < 2 months are at risk for respiratory compromise

45
Q

what causes bronchiolitis?

A

RSV (respiratory syncytial virus)

46
Q

what causes the symptoms in bronchiolitis?

A

inflammation of the bronchioles, secretions into the inflamed bronchial tree

47
Q

what’s the typical presentation of bronchiolitis?

A

begins with URI (copious clear rhinorrhea, mucuous running out of nose)

wheezing

48
Q

what are the breath sounds in bronchiolitis?

A

wheezing

49
Q

in what seasons is bronchiolitis most commonly seen?

A

late fall and throughout the winter

50
Q

how is bronchiolitis spread?

A

respiratory droplets

51
Q

why do kids have tachypnea when have fever?

A

cuz the fever is causing them to breathe fast

-give them ibuprofen and fever comes down and so does the breathing rate

52
Q

descriptions of respiratory distress

A

Retractions
-intercostal, suprasternal, subcostal

Belly breathing

Grunting, Nasal flaring, circumoral cyanosis

Cap refill diminished (>2 sec to refill)

Pallor or Mottling

53
Q

how must you examine child to see if they are in respiratory distress?

A

need to take off their clothes and visualize their chest and belly

54
Q

pulse ox for bronchiolitis?

A

normal to hypoxic

55
Q

if don’t hear wheezing anymore in patient with bronchiolitis, what does that mean?

A

NOT GOOD, means the air is NOT moving

56
Q

bronchiolitis dx

A

CXR (if first episode of wheezing or think pneumonia) - see increased perihilar markings

Nasal Washing (PCR for RSV, but NOT necessary unless meet criteria to do this)

57
Q

when would you do Nasal washing for dx of bronchiolitis?

A

(1) pt < 2-3 months or has underlying RFs
(2) if you will hospitalize pt (changes your tx plan)
(3) if pt is in ED and pap or hospitalist asks you to!

58
Q

outpatient bronchiolitis tx

A

Supportive tx:
-fluids, Tylenol/motrin for fevers, maybe cool mist, PO decadron

IF WORSENING AT HOME (tachypneic w/o fever or if respiratory distress) -> ED immediately

59
Q

when do you use abx for bronchiolitis?

A

if have pneumonia superinfection

60
Q

hospitalize child with bronchiolitis at what O2 sat?

A

<91-93% if awake; <91% if asleep

61
Q

who do you hospitalize for bronchiolitis?

A
  • O2 requirement (<91-93% if awake; <91% if asleep)
  • apneic episodes
  • premie <12 weeks of life
  • Nb-12 weeks and any suggestions of respiratory distress/day 1-3 of illness
  • underlying cardiopulmonary disease
  • parents unable to care for child at home

any child that worries you

62
Q

inpatient bronchiolitis tx

A
  • O2 to keep SpO2 >94%
  • High flow O2 if sats <92% on O2
  • No chest PT
  • No abx unless co-existing pneumonia, OM, etc.

-Intubation if impending respirator failure

63
Q

what’s the course of bronchiolitis? (worsens when?, average course?, how many wheeze again)

A

worsens day 2-5 of illness (vs croup day 2-3)

average course of illness 10-12 days

40% will wheeze again (60% won’t)

64
Q

is bronchiolitis contagious or not contagious?

A

very contagious

65
Q

how can you prevent bronchiolitis?

A

hand hygiene #1

can also get Syngergis Vaccine ppx, but not common b/c expensive

66
Q

does wheezing always mean asthma?

A

NO!!! - other things cause wheezing

67
Q

at what age is a child dx with asthma?

A

5-6 y/o

68
Q

symptoms of asthma

A

dry cough (lasts >3 weeks)

wheeze most likely (expiratory first, but can become inspiratory when gets worse)

69
Q

what’s the expiratory and inspiratory phase like in asthma? what’s normal?

A

asthma = expiratory phase > inspiratory phase

normal is inspiratory phase > expiratory phase

70
Q

asthma and history/associations

A

family h/o asthma (child more likely to get asthma)

atopic illnesses:

  • atopic dermatitis
  • food allergies
  • allergic rhinitis
71
Q

can you say child has asthma with first time wheezing?

A

NO!!! - may be other things

72
Q

tx of mild-intermittent asthma in kids 0-4 y/o or 5-11 y/o

A

SABA (nebulizer or MDI with spacer) - step 1

73
Q

every child with asthma should have what?

A

an asthma action plan

74
Q

breath sounds for Pertussis?

A

whooping cough

75
Q

what causes Pertussis?

A

Bortadella Pertussis

-it’s a gram negative coccobaccilus that colonizes the ciliated epithelium

76
Q

how is pertussis spread? contagious? treat who?

A

through air by respiratory droplets

nearly 100% contagious to non-immunized close contacts (need to treat pt and their close contacts)

77
Q

how effective is Pertussis vaccine?

A

extremely effective but immunity starts to wane at 5 years and gone by 12 years -> NEED BOOSTER!!!

78
Q

what does Pertussis look like?

A

every other pt with a cold

79
Q

what are the 3 stages of Pertussis?

A
  1. Catarrhal stage (most contagious)
  2. Paroxysmal stage
  3. Convalescent stage
80
Q

what is the first stage of Pertussis? sx’s?

A

Catarrhal stage (most contagious)

lasts 1-2 weeks

-URI/common cold sx’s

81
Q

what is the second stage of Pertussis? sx’s?

A

Paroxysmal stage

-lasts 1-6 weeks, but can persists for up to 10 weeks

characteristic sx is a burst, or paroxysm, of numerous, rapid coughs

at the end of the paroxysm, the pt suffers from a long inhaling effort -> high-pitched whoop

82
Q

at what stage of Pertussis does the “whooping” cough occur?

A

the second stage -> Paroxysmal stage

83
Q

what is the third stage of Pertussis? sx’s?

A

Convalescent stage

may last for months

cough usually disappears after 2-3 weeks, but paroxysms may recur whenever the pt suffers any subsequent respiratory infection

84
Q

at what stage is Pertussis most infectious?

A

Catarrhal stage (1st stage)

85
Q

children/infants with paroxysms (second stage of Pertussis) may have…

A
  • Respiratory distress
  • Tongue protruding
  • Face purple
  • Eyes bulging
  • Eyes watery
  • Post-tussive emesis and exhaustion
86
Q

what’s the severity of Pertussis like in children/infants vs adolescents and adults?

A

worse in children/infants

milder in adolescents and adults (coughing in paroxysms with or w/out the WHOOP of whooping cough)

87
Q

dx of Pertussis (true dx, actual dx)

A

Nasopharyngeal swab = true dx
-takes days to weeks to return -> don’t wait for results

high clinical suspicion = clinical dx (actual dx) and treat

88
Q

Pertussis tx

A

Zitrhomax (azithromycin)

  • 10 mg/kg day 1
  • 5 mg/kg day 2-5

Can use erythromycin (but 3x/day for 10 days and causes GI irritation)

Clin Med Peds (10 decks)

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