Peds: Respiration Flashcards by Alixandria Keller

Crackles (Rales): possible causes

bronchiolitis
pulmonary edema
pneumonia
asthma

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Wheezes: possible causes

asthma
bronchiolitis
foreign body

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Rhonchi: possible causes

pneumonia

cystic fibrosis

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Stridor: possible causes

croup
laryngomalacia
subglottic stenosis
allergic rxn
vocal cord dysfunction

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Viral Croup:

age group
MC season
etiology

6mo-5yr

fall/winter

MC: parainfluenza
RSV

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Viral Croup: presentation

nasal congestion/URI 
afebrile
INSPIRATORY STRIDOR
hoarseness
BARKING/SEAL LIKE COUGH
subglottic narrowing 
respiratory distress

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Viral Croup: diagnosis

westley croup score

mild: <2
mod: 3-7
sev: 8+

clinical (retractions)

xray (steeple sign)

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Viral Croup: management: mild

supportive therapy

cool mist

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Viral Croup: management: moderate

corticosteroids (dexamethasone)

epinephrine

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Viral Croup: management: severe

airway support
corticosteroid
epinephrine
+/- admission

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Epiglottitis:

etiology
presentation

Haemophilus influenza type B

sudden onset high fever
insp retractions
rapid onset stridor, muffled voice, dyspnea

DYSPHAGIA
DROOLING
DISTRESS

TRIPOD POSTURING

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Epiglottitis: diagnosis

clinical

xray (lateral: thumb sign)

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Epiglottitis: management

airway support
culture
empiric abx (3rd gen ceph + vanco)

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Bronchiolitis:

what is it
age group
season
etiology

LRTI of sm airways

<2yo (peak: 2-6mo)

Nov - April (peak: jan/feb)

viral (MC: RSV)

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Bronchiolitis: high risk patients

Gestational age <37 weeks
Age <12 weeks
Chronic pulmonary disease
Congenital heart disease
Immunodeficiency
Congenital and anatomic defects of the airways
Neurologic disease

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Bronchiolitis: presentation

URI sx --> LRT sx 
shallow breathing pattern
nasal flaring 
irritability, poor feeding, vomiting
WHEEZING, CRACKLES
coughing, tachypnea, labored breathing, hypoxia

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Bronchiolitis: diagnosis

clinical

also NP swab

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Bronchiolitis: management

supplementary O2
hydration
nasal suctioning

mechanical ventilation

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Respiratory Synctial Virus: high risk patients

Infants < 6 mos &amp; preemies
2nd hand smoke exposure
Respiratory disease
Congenital heart disease
Immune deficiency

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Respiratory Synctial Virus: presentation

URI sx --> diffuse wheezing,
tachypnea
low fever
CRACKLES
PROLONGED EXPIRATION
WHEEZING
RETRACTIONS
congestion
LOTS OF MUCUS

CXR: hyperinflation, peribronchial thickening

Respiratory Synctial Virus: diagnosis

clinical

rapid assay

Respiratory Synctial Virus: treatment

supportive
ribavirin (if IM)
palivizumab (prophylaxis)

Infant Respiratory Distress Syndrome:

aka
what is it

hyaline membrane disease

def of surfactant production + surfactant inactivation by protein leaks into airspaces

What is the MC cause of respiratory distress in preterm infants?

Infant Respiratory Distress Syndrome

Infant Respiratory Distress Syndrome: presentation

hypoxia respiratory distress at birth hypoxemia dec air mvmt CXR: GROUND GLASS APPEARANCE (atelectasis)

Infant Respiratory Distress Syndrome: risk factors

PREMATURITY maternal DM advanced maternal age family history

Infant Respiratory Distress Syndrome: treatment

respiratory support steroids surfactant replacement

Pneumonia: risk factors for pediatrics

Congenital heart disease Bronchopulmonary dysplasia Cystic fibrosis Second hand smoke Lack of routine pediatric vaccinations (Prevnar--PCV 13) Asthma Sickle cell disease Neuromuscular disorders (depressed consciousness) GI disorders (eg, gastroesophageal reflux) Immunodeficiency disorders

Pneumonia: afebrile pneumonia of infancy: MC pathogen

chlamydia trachomatis

Pneumonia: presentation

``` tachypnea, tachycardia fever retractions/nasal flaring GRUNTING (imminent resp failure) dec O2 saturation CRACKLES, RHONCHI DEC AIR MVMT ILL APPEARANCE dehydration, lethargy, irritable ```

Pneumonia: 1-3 months - MC etiology - pathogen

viral: RSV

Pneumonia: 3-12 months - MC etiology - pathogen

viral: RSV

Pneumonia: 2-5 years - MC etiology - pathogen

viral: parainfluenza, influenza, etc

Pneumonia: 5-18 years - MC etiology - pathogen

bacterial: S pneumoniae, atypicals

What is the MCC of bacterial pneumonia in all ages?

S pneumoniae **atypicals also join after 5yo

Pneumonia: diagnosis

xray: - bacterial (air space disease or consolidation in lobar distribution) - viral (interstitial or peribronchial infiltrates) blood/sputum cultures

Pneumonia: treatment

admission (<3-6mo old, hypoxemic) abx: S pneumo: AMOX atypical: macrolide

Pertussis: - pathogen - transmission

bordatella pertussis respiratory droplets

Pertussis: catarrhal phase

phase 1 (1-2wks) URI sx fever

Pertussis: paroxysmal phase

phase 2 (2-6wks) persistent paroxysmal cough inspiratory whooping post tussive emesis

Pertussis: convalescent phase

``` phase 3 (wks-mos) gradual resolution of cough ```

Pertussis: diagnosis

PCR + culture (gold standard) +/-serology CBC (leukocytosis) CXR (normal)

Pertussis: treatment

abx (macrolide, bactrim) prophylaxis for household contacts

Cystic Fibrosis: presentation

high salt content in sweat glands recurrent sinus infx nasal polyps chronic ear infx

Cystic Fibrosis: MC pathogens

early: H flu, S aureus older: pseudomonas

Cystic Fibrosis: MCC of death

respiratory failure (med age: 40yo)

Cystic Fibrosis: diagnosis

newborn screen | sweat test

Cystic Fibrosis: management

airway therapies physiotherapy chest wall oscillation expiratory pressure devices