Peds Pulmonary 1 Flashcards
1
Q
definition of acute epiglottitis
A
acute inflammation in the supraglottic region (top of the airway)
2
Q
is epiglottitis an emergency?
A
YES!!! it’s a medical emergency
3
Q
who gets epiglottitis?
A
kids <6 months y/o
4
Q
why are kids <6 months y/o at risk for epiglottitis?
A
b/c they aren’t fully immunized
5
Q
what 3 organisms cause epiglottitis?
A
(1) Strep pyogenes (also causes strep)
(2) Strep pneumonia
(3) Staph
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
7
Q
breath sounds for epiglottitis?
A
stridor (b/c airway is partially obstructed)
stridor is a LATE FINDING
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
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
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
11
Q
if do lateral neck film on pt with epiglottitis, what sign to do you see on the film?
A
thumb print sign
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
13
Q
if in the ED and pt comes in with epiglottitis, what do you do?
A
Anesthesia STAT to intubate
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
15
Q
what IV antibiotics are used for epiglottitis tx?
A
Ceftriaxone or Cefotaxime x7-10 days (to cover for staph or strep)
16
Q
is epiglottitis contagious or not contagious?
A
NOT CONTAGIOUS (but can get strep if pt has epiglottitis d/t strep)
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
18
Q
what are the breath sounds for croup?
A
seal barking cough and stridor
19
Q
what is croup?
A
inflammation of the larynx, trachea (subglottic area - still the upper airway)
20
Q
what’s the etiology of croup?
A
viral
-Parainfluenza 1, 2, 3
21
Q
who gets croup?
A
age 3 months-5 y/o (peak age of 2 y/o)
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
23
Q
clinical presentation of croup
A
- URI sx’s: day 0-2
- Barking cough (expiratory sound) on days 0-5
24
Q
when does croup worsen?
A
on days 2 and 3 of the barking cough
25
how many days does it take croup to resolve?
5-7 days
26
what's the general PE for croup like?
kids won't be able to find comfortable position, crying with coughing, restless, clingy
27
what's the lung PE for croup like?
NORMAL LUNG SOUNDS B/C NOT A LUNG ISSUE
28
dx of croup
clinical dx
maybe do rapid strep if sore throat (strep can occur with croup)
29
when do you do x-ray for croup?
you don't unless you are concerned about a foreign body
30
outpatient tx for mild-moderate croup w/NO STRIDOR
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
31
if patient with croup and stridor, where do they belong?
in the ED
32
tx for moderate-severe croup w/STRIDOR
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
33
if pt with moderate-severe croup w/STRIDOR has no improvement, what is the tx?
consider continuous racemic after second, IM epi, and consider transfer to PICU
34
what does the RACEMIC EPI by nebulizer do for tx of croup?
opens up the upper airway
35
tx for mild croup?
treat at home
- ***cold night air (open the window)
- humidfied air
- open freezer door
36
croup prognosis?
excellent prognosis
usually self resolving w/in 4-7 days of onset
37
bacterial tracheitis is a ____ condition
emergent condition
38
what is bacterial tracheitis?
bacterial infection of the trachea that can cause complete respiratory failure by blockage of the trachea with swelling and purulent drainage
39
bacterial tracheitis is a rare complication of...
croup
40
what is bronchiolitis?
inflammation of the bronchioles (b/w the bronchi and the alveoli)
bronchioles = lower respiratory tract
41
what do you get in the bronchioles in bronchiolitis/
a lot of mucus
42
who gets bronchiolitis?
kids < 2 y/o (b/c have very small bronchioles)
43
bronchiolitis is more common in...
boys, non-breast fed babies, babies born to moms who smoke
44
what kids with bronchiolitis are at a greater risk for morbidity/mortality?
kids with underlying cardiopulmonary disease (premies, asthmatics, immune compromised patients)
kids < 2 months are at risk for respiratory compromise
45
what causes bronchiolitis?
RSV (respiratory syncytial virus)
46
what causes the symptoms in bronchiolitis?
inflammation of the bronchioles, secretions into the inflamed bronchial tree
47
what's the typical presentation of bronchiolitis?
begins with URI (copious clear rhinorrhea, mucuous running out of nose)
wheezing
48
what are the breath sounds in bronchiolitis?
wheezing
49
in what seasons is bronchiolitis most commonly seen?
late fall and throughout the winter
50
how is bronchiolitis spread?
respiratory droplets
51
why do kids have tachypnea when have fever?
cuz the fever is causing them to breathe fast
-give them ibuprofen and fever comes down and so does the breathing rate
52
descriptions of respiratory distress
Retractions
-intercostal, suprasternal, subcostal
Belly breathing
Grunting, Nasal flaring, circumoral cyanosis
Cap refill diminished (>2 sec to refill)
Pallor or Mottling
53
how must you examine child to see if they are in respiratory distress?
need to take off their clothes and visualize their chest and belly
54
pulse ox for bronchiolitis?
normal to hypoxic
55
if don't hear wheezing anymore in patient with bronchiolitis, what does that mean?
NOT GOOD, means the air is NOT moving
56
bronchiolitis dx
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
when would you do Nasal washing for dx of bronchiolitis?
(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
outpatient bronchiolitis tx
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
when do you use abx for bronchiolitis?
if have pneumonia superinfection
60
hospitalize child with bronchiolitis at what O2 sat?
<91-93% if awake; <91% if asleep
61
who do you hospitalize for bronchiolitis?
- 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
inpatient bronchiolitis tx
- 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
what's the course of bronchiolitis? (worsens when?, average course?, how many wheeze again)
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
is bronchiolitis contagious or not contagious?
very contagious
65
how can you prevent bronchiolitis?
hand hygiene #1
can also get Syngergis Vaccine ppx, but not common b/c expensive
66
does wheezing always mean asthma?
NO!!! - other things cause wheezing
67
at what age is a child dx with asthma?
5-6 y/o
68
symptoms of asthma
dry cough (lasts >3 weeks)
wheeze most likely (expiratory first, but can become inspiratory when gets worse)
69
what's the expiratory and inspiratory phase like in asthma? what's normal?
asthma = expiratory phase > inspiratory phase
normal is inspiratory phase > expiratory phase
70
asthma and history/associations
family h/o asthma (child more likely to get asthma)
atopic illnesses:
- atopic dermatitis
- food allergies
- allergic rhinitis
71
can you say child has asthma with first time wheezing?
NO!!! - may be other things
72
tx of mild-intermittent asthma in kids 0-4 y/o or 5-11 y/o
SABA (nebulizer or MDI with spacer) - step 1
73
every child with asthma should have what?
an asthma action plan
74
breath sounds for Pertussis?
whooping cough
75
what causes Pertussis?
Bortadella Pertussis
-it's a gram negative coccobaccilus that colonizes the ciliated epithelium
76
how is pertussis spread? contagious? treat who?
through air by respiratory droplets
nearly 100% contagious to non-immunized close contacts (need to treat pt and their close contacts)
77
how effective is Pertussis vaccine?
extremely effective but immunity starts to wane at 5 years and gone by 12 years -> NEED BOOSTER!!!
78
what does Pertussis look like?
every other pt with a cold
79
what are the 3 stages of Pertussis?
1. Catarrhal stage (most contagious)
2. Paroxysmal stage
3. Convalescent stage
80
what is the first stage of Pertussis? sx's?
Catarrhal stage (most contagious)
lasts 1-2 weeks
-URI/common cold sx's
81
what is the second stage of Pertussis? sx's?
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
at what stage of Pertussis does the "whooping" cough occur?
the second stage -> Paroxysmal stage
83
what is the third stage of Pertussis? sx's?
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
at what stage is Pertussis most infectious?
Catarrhal stage (1st stage)
85
children/infants with paroxysms (second stage of Pertussis) may have...
- Respiratory distress
- Tongue protruding
- Face purple
- Eyes bulging
- Eyes watery
- Post-tussive emesis and exhaustion
86
what's the severity of Pertussis like in children/infants vs adolescents and adults?
worse in children/infants
milder in adolescents and adults (coughing in paroxysms with or w/out the WHOOP of whooping cough)
87
dx of Pertussis (true dx, actual dx)
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
Pertussis tx
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)
