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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
Q

What are the two steps of Asthma treatment

A
  1. What is the level of severity

2. What is the level of control

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26
Q

Define well controlled Asthma

A

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
Q

Rule of 2s for Asthma Tx

A

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
Q

What is the role of Ipatropium in asthma (peds)

A

Adjunct if minimal improvement after albuterol treatment

Often co-administered with albuterol (Duoneb)

29
Q

Oral Steroids and Inhaled Steroids to use in Asthma Peds Pts

A

Oral : Prednisone/ Dexamethasome

Inhaled: Fluticasone (1st line)
-reduced short time growth velocity in kids

30
Q

What is the Rx that is used in exercise induced asthma AND concurrent allergic rhinitis

A

Leukotriene receptor antagonists (i.e., montelukast)

31
Q

IF a pt is in need of a LABA in asthma

What is the role of the PA

A

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
Q

What is the role of Epinephrine in ASthma Pts

A

Administer IM

Status asthmaticus

Indicated for: Severe asthma associated w/ anaphylaxis or unresponsive to short-acting bronchodilators

33
Q

What is the role of Omalizumab in asthma pts

A

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
Q

Which are better MDI or Nebulizers

A

MDIs w/ spacers are as effective as nebulizers

35
Q

What is the approach for intermittent vs persistent asthma

A

Intermittent asthma: intermittent use of albuterol

Persistent asthma (mild, moderate, or severe)
→ initiate inhaled corticosteroid
(preferred; alternatively, leukotriene receptor antagonist)

36
Q

What is the ED tx for status asthmaticus

A

continuous albuterol, IM steroids, PICU

Avoid intubation if possible!

37
Q

What are the three stages of pertussis

A

Catarrhal stage (1-2 weeks)

Paroxysmal Stage (2-4 weeks)

Convalescent stage (1-2 weeks)

38
Q

Catarrhal Pertussis stage

A

Non-specific signs (nasal secretions & low-grade fever)

39
Q

Paroxysmal Stage of Pertussis

A

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
Q

Convalescent stage of Pertussis

A

Decreasing symptoms (cough, paroxysms, whoops)

41
Q

How do infants less than 3 months present with whooping cough/ pertusssis

A

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
Q

Any infant that presents with apnea and cyanosis

Should get what lab?

A

R/o pertussis

43
Q

Prominent cough with NO fever, malaise or myalgia, exanthem, sore throat, hoarseness, tachypnea, wheezes or rales

Think

A

Pertussis

44
Q

Older children with a cough that is ESCALATING at 7-10 days
AND coughing in spurts

Think

A

Pertussis

45
Q

Lymphocyte-dominant leukocytosis

Think

A

Pertussis

46
Q

Test of choice for pertussis

A

PCR (polymerase chain reaction) of nasopharyngeal wash is lab test of choice in early phases

47
Q

What is the Drug of Choice for pertussis mgmt

A

Azithromycinis the drug of choice in all age-groups
treatment or postexposure prophylaxis

If less than 3 months= ADMIT

48
Q

What is the prevention for pertussis

A

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
Q

All close contacts exposed to pertussis should get what ABX

A

prophylactic macrolide
(azithromycin x 5 days
or clarithromycin
or erythromycin x 7-14 days)

50
Q

What is the #1 cause of Bronchilolitis

A

Respiratory syncytial virus (RSV) 50%

51
Q

Peak age of bronchiolitis

A

2-6 months

52
Q

6 month old presents with low grade fever and increased work of breathing, nasal flares and intercostal retraction

Think

A

Bronchiolitis

53
Q

Treatment for Bronchiolitis

A

Supportive, prevent dehydration

Do not give meds or ABX

54
Q

What is the role of Palivizumab for Bronchiolitis prevention

A

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
Q

Most common etiology of PNA in neonates

A

Group B streptococcus (GBS)
Escherichia coli
Streptococcus pneumoniae

56
Q

most common PNA in age 1mo-5 years

A

Viruses (RSV #1, parainfluenza, influenza)!!
Streptococcus pneumoniae
Haemophilus influenza (type B & nontypable)

57
Q

MC PNA in peds over 5 yrs

A

Mycoplasma pneumoniae
Streptococcus pneumoniae
Chlamydophyla pneumoniae

58
Q

What is the 1st sign of PNA in neonates and young peds

A

fever, apnea, hypoxia often ONLY signs

apnea often 1st sign of pneumonia!

59
Q

How does bacterial vs viral NA present on CXR

A

Bacterial findings: lobar consolidation, pleural effusion

Viral findings: diffuse infiltrates, hyperinflation

60
Q

What is the ABX for bacterial suspected PNA

A

amoxicillin 80-90 mg/kg/day 1st line for most

61
Q

Admission Criteria for PNA

A

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
Q

ABX for atypical PNA

A

If you suspect atypical bacteria:
->Azithromycin, clarithromycin, doxycycline (for children >7)

Can do combination therapy with amoxicillin

63
Q

ABX for INpt PNA in neonates

A

Ampicillin/gentamycin
Or penicillin G
(local epidemiologic data documents lack of substantial S. pneumoniae resistance)

Staphylococcus aureus concern → vancomycin

HSV → acyclovir

64
Q

INpt tx for PNA in older pts

A

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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