PULM Flashcards
How is a child’s tongue differ in comparison to adults?
Huge tongue in comparison to a small airway
What are sxs of respiratory distress?
Tachycardia, retractions, grunting, nasal flaring, head bobbing, abdominal breathing, and tripod position
If a child has a cough that sounds like the bark of a seal with inspiratory stridor, with coughing fit at night, what diagnosis? What causes it?
Croup
Caused by parainfluenza affecting the larynx
How do you confirm diagnosis of croup? How do you treat it?
Diagnosis = chest xray looking for the steeple sign (can be diagnosed clinically)
Treat = cool air/moist air & single dose decadron (steroid); respiratory distress racemic epi + O2
If a child has rapid onset of severe respiratory distress, high fever, drooling, stridor and no cough, but they’re in the tripod position – what diagnosis?
Epiglottitis
How do you diagnose epiglottitis?
NEVER ATTEMPT TO VISUALIZE THE AIRWAY Do a lateral neck xray for “thumb sign”
What vaccine prevents epiglottitis? How do you treat it?
HiB vaccine
Treat with Abx & secure the airway
If a child has myalgia’s, fever, chills, with a runny nose, and sore throat – what diagnosis do you need to think of?
Influenza
How do you diagnose influenza?
PCR nasal swab & negative chest-xray
How do you treat influenza?
antipyretics for fever, oseltamivir (within 48 hours), Relenza, and close F/U of 6mo-1 year olds
If an infant had a recent URI exposure with increase in nasal congestion and cough. And has a gradual onset of fever, poor feeding, expiratory wheeze (respiratory distress) – what diagnosis?
RSV (AKA Bronchiolitis)
How would you confirm diagnosis of RSV and what might you see on PE?
Confirm with RSV nasal swab & hyperinflation chest xray
PE you might see retractions, “junky” lung sounds, and low O2 sat
What stage of pertussis would see post-tussive vomiting & and an inspiratory whoop?
2nd Paroxysmal stage (lasts 1-6 weeks)
What abx do you use to treat pertussis?
Macrolide (Azith & clarithro)
If you hear focal crackles, rales in a child with fever and lethargy – what diagnosis?
Pneumonia
How do you confirm diagnosis of pneumonia?
Chest xray (consolidation & “round appearing)
How do you treat pneumonia?
High dose Amoxicillin (or macrolide)
At what point do you admit a child?
O2 sat 70 in infants or >50 in children
If a child has recurrent respiratory infections with thick mucus/cough – what diagnosis do you not want to miss?
Cystic fibrosis
What is occurring in cystic fibrosis? What else do you need to ask about with recurrent respiratory infections with thick mucus cough (that you suspect is cystic fibrosis)?
Abnormalities of salt/water transport → mucus retention. Always ask about stools!!! Greasy, foul-smelling stools that float indicate cystic fibrosis
How do you confirm diagnosis of cystic fibrosis?
Positive sweat test >60mEq/L
If a child has a cough and wheeze every time they work out – what diagnosis?
Asthma (exercise induced)
How do you diagnose asthma?
PFT’s! Showing a low FEV1/FVC ratio; then give a bronchodilator – if it improves by 12% = asthma
In general, how do you treat asthma?
Albuterol & Steroids (once older you can use higher dose steroids)
When does SIDS peak? And when does it occur?
2-4 months
Occurs during sleep
What are some risk factors for SIDS?
Exposure to cigarette smoke, mom less than 20, premature/low birth weight, sleeping on stomach, soft bedding with blankets, and sharing a bed with a child less than 3 months
IF a premature neonate begins to show signs of respiratory distress within the first few hours of life – what diagnosis do you need to think of and what diagnostic do you need to do?
Hyaline membrane disease (RDS)! Get a chest xray to see “ground glass appearance”
What’s occurring in RDS?
Deficiency in surfactant, in a premature baby (less than 37 weeks)
How do you treat hyaline membrane disease?
Give corticosteroids & surfactant (especially during labor if less than 37 weeks)
