Pulm Flashcards
Tx for asthma
Patient ed: use of spacer, shaking canister, home monitoring, prevention or environment control
SaβAs: albuterol, levalbuterol
LaβAs: salmeterol, formoterol
Inhaled steroids
Anticholinergics aren’t as helpful in kids
Mast cell stabilizers: cromolyn, nedocromil
Leukotriene inhibitors
Refer for acute life-threatening attack, mod-severe asthma, steroid-dependent asthma, complicated asthma, poor response to optimal therapy
SaβAs
albuterol, levalbuterol
LaβAs
salmeterol, formoterol
Inhaled steroids
beclomethasone (required trial for Medicaid), fluticasone, budesonide, mometasone, ciclesonide, triamcinolone, flunisolide
Mast cell stabilizers
cromolyn, nedocromil
Leukotriene inhibitors
montelukast, zileuton, zafirlukast
Croup etiology
Usually parainfluenza virus
Croup presenttaion
Stridor, hoarseness, barking seal cough, low-grade fever
Rales, rhonchi, wheezing
Sx worse at night
Croup tx
Supportive: cool mist humidifier
Send to ED for inhaled epinephrine if severe or if there is stridor at rest
Steroids
Acute bronchiolitis etiology
RSV
Acute bronchiolitis presentation
Rhinorrhea, sneezing, wheezing, low grade fever, nasal flaring, tachypnea, retractions that indicate respiratory distress
Acute bronchiolitis w/u
Nasal washings for RSV cx and antigen assay
Nrml CBC and CXR
Acute bronchiolitis tx
Hospitalize and admin ribavirin
Supportive tx- nebulized albuterol, IV fluids, antipyretics, chest physiotherapy, humidified O2
signs of upper airway foreign body
causes abrupt onset of cough, stridor, choking, and cyanosis; complete obstruction leads to inability to cough or choke
signs of lower airway foreign body
causes acute to subacute cough, unilateral persistent wheezing, and recurrent pneumonia; complete obstruction may cause a ball valve effect, resulting in distal hyperinflation and mediastinal shift, which is most apparent on expiratory films
cystic fibrosis tx
Clearance of airway secretions, reversal of bronchoconstriction,
tx of respiratory infections, replacement of pancreatic enzymes, and nutritional and psychosocial support
Hyaline Membrane Disease presentation
Respiratory distress and cyanosis soon after birth (usually w/in first 4 hr of life)
Tachypnea, tachycardia, chest wall retractions, nasal flaring, abd breathing
Hyaline Membrane Disease tx
Inpatient with fluid balance, CPAP, exogenous surfactant
Prevention: betamethasone for women at risk for preterm deliery prior to 34 wks
If >30 wks FLM can be tested by amniocentesis
Hyaline Membrane Disease w/u
CXR →x diffuse ground glass appearance w/ air bronchogram
Pneumonia etiology
Bacterial: Strep pneumo, S. pyogens, S. aureus, H. flu, M. pneumo
Viral: RSV, influenza, parainfluenza, adenovirus
Pneumonia presentation
Tachypnea, hyoxemia, ↑ work of breathing, fever, productive cough, difficult feedings
Crackles, ↓ breath sounds, dullness to percussion, egophany
Pneumonia tx
Inpatient → IV ampicillin is 1st line, 2nd or 3rd gen cephalosporins w/ or w/o vanc, consider macrolide (in 1-3 mo)
Outpatient → first line is high dose amoxicillin alt is 2nd or 3rd gen cephalosporins or azithromycin(should have nrml O2 sat and be able to take oral fluids)
RSV tx
Supportive
May need hospitalization w/ fluid and respiratory support
Albuterol trial, Steroids (not for infants)
Ribavirin for select infants
Who should get vaccinated for RSV
Preemies <32 wks or who are <3 mo at start of RSV season CLD, heart defect, asthma, immunocomp
