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Senoir 21-2 > PEDS RR > Flashcards

PEDS RR Flashcards

1
Q

Harsh sound caused by partially obstructed extrathoracic airway
More commonly heard during inspiration

A

Stridor

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2
Q

Partial obstruction of the lower airways

More commonly heard during expiration

A

Wheezing

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3
Q

Irregular coarse rattling due to secretions in intrathoracic airways

A

Rhonchi

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4
Q

Fluid/secretions in small airways produce sounds like crumpling cellophane

A

Rales (crackles)

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5
Q

What is the narrowest part of the airway in children

A

Children <3 years: cricoid ring → narrowest portion of airway

Older children & adults: glottis → narrowest portion of airway

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6
Q

What is the most common cause of stridor in peds

A

Upper airway obstruction:

Most common cause in infants: laryngomalacia (floppy larynx)

Aggravated by swallowing problems & gastroesophageal reflux

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7
Q

Most common causes of CROUP

A

PAIR!

Parainfluenza (75%)
Adenovirus
Influenza
RSV

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8
Q

Age range for croup

A

Children 6 mo-3 years, peak at 2-3yo

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9
Q

What is the MGMT approach to Croup

A

Airway management and treatment of hypoxia

Racemic epi
(watch for rebound effects

+dexamethasone
(Shortens hospital stays)

If severe: Intubation

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10
Q

What is the criteria for admission for Croup

A

Multi dose of racemic Epi

Age <6 months

Multiple ED visits in 24 hrs

Suspicion of secondary bacterial infection

Stridor at rest

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11
Q

Common agents of epiglottitis

A

Group A streptococcus, S. aureus; H. influenza type B
or diphtheria
(unimmunized patients)

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12
Q

How do you dx epiglottis

A

Dx: direct observation of inflamed, swollen supraglottic structures & swollen, cherry-red epiglottitis

Perform in OR w/ anesthesiologist & surgeon → can place an endotracheal tube, or emergency tracheostomy , ET not possible

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13
Q

What is the tx for epiglottis

A

antibiotic therapy IV
+/- steroids

endotracheal intubation remains as long as needed to maintain airway

Rapid recovery; most children can be extubated w/in 48-72 hrs

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14
Q

What vaccination prevents Epiglottis

A

HiB vaccination

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15
Q

What is the most common cause of airway obstruction in peds

A

Infants most common cause: liquids

Older children common causes:
Grapes, nuts, hot dogs, candy

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16
Q

ANY child in the proper setting with the sudden onset of choking, stridor, or wheezing has….

A

foreign body aspiration until proven otherwise.

First time wheezer, especially if unilateral, needs x-ray!!

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17
Q

What are the 2 phases of Asthma

A

Early → bronchospasm

Late → airway inflammation

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18
Q

What is the pulsus paradoxus in asthma

A

Pulsus Paradoxus

-Decrease in BP >15mmHg with inspiration

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19
Q

When are PFTs used in asthma Dx in peds

A

An adjunct to clinical suspicion in peds

Establishes diagnosis, directs treatment, monitors treatment response, & assesses disease progression

Diagnostic: Obstructive pattern after a stimulus (i.e., exercise or methylcholine challenge) & reversibility w/ β agonist

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20
Q

When to get CXR in peds pts

A

Baseline at time of initial presentation to r/o other diseases/anatomic abnormalities

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21
Q

Intermittent Asthma Classification

A

Daytime S/s less than 2 days a week

With less than 2 (age >5) or 0 (age 0-4) night time awakenings

Using a SABA less than 2 days a week

With NO INTERFERENCE IN NML ACTIVITY

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22
Q

MILD Asthma Classification

A

Day time s/s > 2 days a week but NOT DAILY

Night time awakenings
(Age 0-4) 1-2 x a MONTH
(Age >5) 3-4 x a MONTH

SABA use more than 2 days a week
But NOT DAILY and not more than one time a day

Minor Limiations of Activity

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23
Q

Moderate Asthma

A

DAILY S/s

Night awakenings
(0-4) 3-4 x a month
(>5yrs) more that 1 x a week but NOT NIGHTLY

SABA use daily

Interference with SOME limitation

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24
Q

Severe Asthma classification

A

Daytime S/s repeatedly throughout the day

NIght time awakening
(0-4) more than 1 x a WEEK
(>5yrs) often every night

SABA use several times per day

And extreme activity limitation

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25
What are the two steps of Asthma treatment
1. What is the level of severity | 2. What is the level of control
26
Define well controlled Asthma
S/s less than 2 days a week but not more than once a day Less than 1 x a month of awakenings With no interference into dialy activities FEV1 >80%
27
Rule of 2s for Asthma Tx
Rule of Twos → determine need for daily anti-inflammatory medication: -Daytime symptoms → ≥2 times/week OR -Nighttime awakening → ≥2 times/month Increase (stepped up) & decrease (stepped down) therapy as needed
28
What is the role of Ipatropium in asthma (peds)
Adjunct if minimal improvement after albuterol treatment | Often co-administered with albuterol (Duoneb)
29
Oral Steroids and Inhaled Steroids to use in Asthma Peds Pts
Oral : Prednisone/ Dexamethasome Inhaled: Fluticasone (1st line) -reduced short time growth velocity in kids
30
What is the Rx that is used in exercise induced asthma AND concurrent allergic rhinitis
Leukotriene receptor antagonists (i.e., montelukast)
31
IF a pt is in need of a LABA in asthma What is the role of the PA
Do NOT use as single therapy → increased exacerbations & death Should only be used in combination w/ inhaled steroids for chronic asthma management Typically, if considering need for this, send to Pulmonology!!
32
What is the role of Epinephrine in ASthma Pts
Administer IM Status asthmaticus Indicated for: Severe asthma associated w/ anaphylaxis or unresponsive to short-acting bronchodilators
33
What is the role of Omalizumab in asthma pts
Anti-IgE monoclonal antibody → prevents IgE binding to basophils & mast cells Moderate to severe allergic asthma in 12 yrs or older Subcutaneous injection every 2-4 weeks
34
Which are better MDI or Nebulizers
MDIs w/ spacers are as effective as nebulizers
35
What is the approach for intermittent vs persistent asthma
Intermittent asthma: intermittent use of albuterol Persistent asthma (mild, moderate, or severe) → initiate inhaled corticosteroid (preferred; alternatively, leukotriene receptor antagonist)
36
What is the ED tx for status asthmaticus
continuous albuterol, IM steroids, PICU Avoid intubation if possible!
37
What are the three stages of pertussis
Catarrhal stage (1-2 weeks) Paroxysmal Stage (2-4 weeks) Convalescent stage (1-2 weeks)
38
Catarrhal Pertussis stage
Non-specific signs (nasal secretions & low-grade fever)
39
Paroxysmal Stage of Pertussis
Cough starts as dry, intermittent, irritative hack Distinctive stage: paroxysmal coughing (expiration) → lose their breath (clustered violent coughing fits) Posttussive emesis—esp in older children Exhaustion
40
Convalescent stage of Pertussis
Decreasing symptoms (cough, paroxysms, whoops)
41
How do infants less than 3 months present with whooping cough/ pertusssis
No classic stages Catarrhal phase is a few days, or unnoticed After a startle, they can choke, gasp, gag, flail with red face Cough may not be prominent, not classic whoop Apnea and cyanosis can follow a coughing paroxysm, or apnea alone—CNS damage!
42
Any infant that presents with apnea and cyanosis Should get what lab?
R/o pertussis
43
Prominent cough with NO fever, malaise or myalgia, exanthem, sore throat, hoarseness, tachypnea, wheezes or rales Think
Pertussis
44
Older children with a cough that is ESCALATING at 7-10 days AND coughing in spurts Think
Pertussis
45
Lymphocyte-dominant leukocytosis Think
Pertussis
46
Test of choice for pertussis
PCR (polymerase chain reaction) of nasopharyngeal wash is lab test of choice in early phases
47
What is the Drug of Choice for pertussis mgmt
Azithromycin is the drug of choice in all age-groups treatment or postexposure prophylaxis  If less than 3 months= ADMIT
48
What is the prevention for pertussis
DTaP vaccine: 2, 4, 6, & 15-18 mos w/ booster at 4-6 yo Tdap single booster: 11-12 yo, adults, pregnant patients w/ each pregnancy
49
All close contacts exposed to pertussis should get what ABX
prophylactic macrolide (azithromycin x 5 days or clarithromycin or erythromycin x 7-14 days)
50
What is the #1 cause of Bronchilolitis
Respiratory syncytial virus (RSV) 50%
51
Peak age of bronchiolitis
2-6 months
52
6 month old presents with low grade fever and increased work of breathing, nasal flares and intercostal retraction Think
Bronchiolitis
53
Treatment for Bronchiolitis
Supportive, prevent dehydration Do not give meds or ABX
54
What is the role of Palivizumab for Bronchiolitis prevention
Palivizumab: IM injection of RSV-specific monoclonal antibody Indications: (Change periodically) - Under 24 months of age - Prematurity (<29 wks gestation) - Chronic lung disease of prematurity (<32 wks at birth) Significant congenital heart disease in 1st yr of life (rarely in 2nd yr of life)—Gestational age doesn’t affect Given before onset of RSV season! Then every month during the season,.
55
Most common etiology of PNA in neonates
Group B streptococcus (GBS) Escherichia coli Streptococcus pneumoniae
56
most common PNA in age 1mo-5 years
Viruses (RSV #1, parainfluenza, influenza)!! Streptococcus pneumoniae Haemophilus influenza (type B & nontypable)
57
MC PNA in peds over 5 yrs
Mycoplasma pneumoniae Streptococcus pneumoniae Chlamydophyla pneumoniae
58
What is the 1st sign of PNA in neonates and young peds
fever, apnea, hypoxia often ONLY signs apnea often 1st sign of pneumonia!
59
How does bacterial vs viral NA present on CXR
Bacterial findings: lobar consolidation, pleural effusion Viral findings: diffuse infiltrates, hyperinflation
60
What is the ABX for bacterial suspected PNA
amoxicillin 80-90 mg/kg/day 1st line for most
61
Admission Criteria for PNA
Age <6 months (some exceptions) Immunocompromised state Toxic appearance(DUH) Moderate to severe respiratory distress Hypoxemia (oxygen saturation <90% breathing room air at sea level---altitude lower threshold) Complicated pneumonia  Sickle cell anemia with acute chest syndrome Vomiting or inability to tolerate oral fluids or medications Severe dehydration No response to appropriate oral antibiotic therapy Social factors (e.g., inability of caregivers to administer medications at home or follow-up appropriately)
62
ABX for atypical PNA
If you suspect atypical bacteria: ->Azithromycin, clarithromycin, doxycycline (for children >7) Can do combination therapy with amoxicillin
63
ABX for INpt PNA in neonates
Ampicillin/gentamycin Or penicillin G (local epidemiologic data documents lack of substantial S. pneumoniae resistance) Staphylococcus aureus concern → vancomycin HSV → acyclovir
64
INpt tx for PNA in older pts
Atypical causes more common—Azithromycin Hib coverage needed as well—Ampicillin PICU: 3rd gen cephalosporin (Cefuroxime, Ceftriaxone) Viral causes still present and need supportive care THESE ARE IV meds!

Senoir 21-2 (77 decks)

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