Peds Pulmonary Flashcards
Viral croup
- fall/winter
- inspiratory stridor**
- hoarsness**
- cough, barking, “seal-like”
Viral croup: cause
- Parainfluenza virus type 1
2. RSV
Westley Croup Score
Mild <2
Moderate 3-7
Severe: >8
- LOC
- Cyanosis
- Stridor
- Air entry
- Retractions
What sign is seen on radiograph to help dx viral croup?
“steeple sign”
Moderate Croup (>3) treatment
- Dexamethasone IM or IV
2. Nebulized racemic epinephrine
Epiglotitis cause
Haemophilus influenza type B
-bacterial
Epiglottitis: 3 D’s
Dysphagia
Drooling
Distress
-Tripod posturing “sniffing dog position”*****
Don’t use a tongue blade**
Epiglottitis: Radiograph
“thumb sign” [lateral neck film]
Epiglottitis: tx
- Airway support
- Antibiotics: 3rd gen cephalosporin + Vancomycin
Bronchiolitis
lower respiratory tract infection
- affects pts. under 2
- peaks in January and February
Bronchiolitis: cause
RSV
Bronchiolitis: signs and symptoms
- difficulty breathing (shallow, rapid, with nasal flaring)
- Wheezing, crackles on exam**
Bronchiolititis: tx
- nasal suction
- hydration
Respiratory Syncytial Virus
Most important cause of lower respiratory tract infection in children under 1 year
-causes most bronchiolitis
RSV: xray
- hyperinflation*
- peribronchial thickening*
RSV: physical exam
- crackles
- prolonged expiration
- wheezing
- retractions
- lots of mucus**
What is the most common cause of respiratory distress in preterm infant?
Infant Respiratory Distress Syndrome (RDS) “Hyaline Membrane Disease”
What is the biggest risk factor for Infant Respiratory Distress Syndrome
-premature birth (<37 weeks, esp if <28 weeks)
If a lil baby has grunting what should you be concerned for?
imminent respiratory failure
MCC PNA 1-12 months
RSV
MCC PNA 2-5 years?
Viral
MCC PNA 5-18 years
Bacterial (S. pneumoniae)
What is first line treatment for PNA if they are under 5?
Amoxicillin
What is the first line treatment for PNA if they are older than 5?
Macrolide (Azithromycin)
What is the most common cause of afebrile pneumonia of infancy?
Chlamydia trachomatis
-staccato cough pattern
Pertussis (whooping cough): cause
Bordatella pertussis
What are the 3 phases of pertussis/whooping cough?
- Catarrhal (URI symptoms, fever)
- Paroxysmal ( inspiratory whooping cough, persistent paroxysmal cough)
- Convalescent
Pertussis: dx
PCR and culture of nasal secretions (gold standard)**
CXR: normal
Pertussis: treatment
Macrolides ** (or TMP-SMX)
Prophylaxis for household (close contacts, even if they are vaccinated)
