Pulm Lecture Flashcards
Larger head
Smaller mandible, small neck
Large tongue, posteriorly placed
Tonsils and adenoids present
Smaller airways
Less rigid throacic cage
Increased metabolick rate
Increased O2 demand
Differences of pediatric respiratory system
Tachycardia
Retractions- intercostal and sternal
Grunting, nasal flaring
Head bobbing
Abnormal breathing
Tripod position
Pediatric respiratory distress
Laryngotracheobronchitis, AKA
Croup
Pathophys: parainfluenza, affects the larynx
causes subglottic edema, airflow obstruction
Affects ages 6 mos to 3 years
males>females
Fall, early winter MC
Croup
“Seal, barky” cough
Inspiratory stridor
Respiratory distress (retractions), low O2 stats, cynosis, sometimes low grade fever
coughing fits at night (due to increased edema)
Croup
Diagnosis:
Clinical diagnosis
Steeple sign on CXR
Croup
Tx:
Single dose of Decadron
Moist vs cool air, tylenol for fever
Croup
Bacterial infection with H. influenza
Affects the epiglottis with cellulitis/edema
causes airway obstruction
affects kids 4-7 yo
decreased incidence due to HiB vaccination
Epiglottitis
Rapid onset, severe distress within hours
High fever, difficulty swallowing or sore throat
drooling, stridor
No cough*
TRIPOD POSITION
Epiglottitis
DO NOT ATTEMPT TO VISUALIZE AIRWAY
lateral soft tissue neck X ray shows thumb sign
**this is a medical emergency!!
Epiglottitis
Tx:
Antipyretics for fever IV antibiotics (Rocephin) Secure airway- may need to intubate
Epiglottitis
Acute respiratory infection caused by influenza A or B
Present winter months, community outbreaks
Vaccine for prevention (do not give if pt has egg allergy)
Affects adults and children
s/s: myalgias, fever, chills, runny nose, HA, sore throat
Dx: PCR nasal swab
Tx: antipyretcs, tamiflu within 48 hours of sxs
Influenza
AKA Bronchiolitis (inflamed bronchial tubes)
RNA paramyxovirus
Causes air trapping
Seasonal airbreaks (mostly during winter)
children under 2 (peak incidence at 6 mos)
Respiratory Syncytial Virus (RSV)
S/S:
Recent URI exposure, increase in nasal congestion, cough
gradual onset of respiratory distress
fever, poor feeding, expiratory wheezing
“junky” lung sounds, retractions, tachypnea, low O2 sat
RSV
Dx:
Nasal swab
hyperinflation on CXR
Tx:
Supportive tx, self-limited
RSV
“whooping cough”
All ages of children
3 stages:
- catarrhal stage: 1-2 weeks, URI symptoms, fever, cough, runny nose
- paroxysmal stage: 1-6 weeks, post tussive vomiting, inspiratory whoop
- convalescent stage: 2-3 weeks, cough lessens
Pertussis
Which stage of pertussis lasts 1-6 weeks and consists of:
post-tussive vomiting
inspiratory whoop
Paroxysmal stage
What stage of pertussis lasts 1-2 weeks and consists of:
URI symptoms
Fever
Cough
Runny nose
Catarrhal stage
Which stage of pertussis is the recovery stage that lasts 2-3 weeks, cough lessens
Convalescent stage
Dx: culture/PCR nasal swab
Tx: macrolide antibiotics (Azithro, Clarithro)
**treat all family members***
Pertussis
Infection of the lower respiratory tract
MC pathogens: strep pneumonia, H.influezae, mycoplasma
Pneumonia
S/S:
Fever, cough
rapid breathing/tachypnea
dypnea
low oxygen sat
lethargy
focal crackles/rales on ausculation
Pneumonia
Dx:
CXR shows consolidation, “round appearing”
CBC shows WBC > 15k
Tx:
Amoxicillin (1st choice)
or Macrolide (Azithro)
Pneumonia
Pneumonia in a child with….
Oxygen sat <92%
RR >70 in infant or >50 in child
Intermittent apnea or grunting
Dehydration
Family unreliable
Admit!
When should a child follow up with a pediatrician after a pneumonia dx?
within 24-48 hours
Viral or bacteria pneumonia?:
Gradual onset
Recent URI symptoms
CXR shows interstitial infiltrates
Viral pneumonia
Genetic-multi systemic disease. avg survival is 38 years
abnormality in the cystic fibrosis transmembrane conductance regulator (CFTR)
abnormalities of salt and water transport across epithelial surfaces affecting the lungs and GI system
*MUCUS RETENTION
Cystic fibrosis
Pancreas dysfunction: calorie malabsorption bc pancreas becomes obstructed
Lung disease: cycle of mucus retention, injection and inflammation
Cystic fibrosis
S/S:
Positive newborn screen (elevated ImmunoReactive Trypsinogen)
Failure to pass meconium at birth, or bowel obstruction at birth
Recurrent respiratory infections! (thick mucus, wheezing, cough)
greasy, foul smelling stools that float
99% of males are sterile
clubbing of fingers
Cystic fibrosis
Dx: positive sweat test > 60 mEq/L
Tx: mucus thinners, airways clearance (chest PT), inhalers, lung transplant, frequent abx, supplemental pancreas enzymes, etc
Cystic fibrosis
Lower airway hypersensitivity to:
allergies, irritants, exercise, infection
chronic airway inflammatory disorder affecting mast cells, eosinophils, lymphocytes
inflammation –>bronchospasm –>bronchial edema –>increased mucus
Asthma
S/S:
Episodic dry cough
wheezing
respiratory distress (nasal flaring, retractions)
reucrrent symptoms, presence of triggers (exercise, cold air, allergens)
associated with nasal polyps and atopic dermatitis
Asthma
Dx:
PFTs
Spirometry shows < FEV1:FVC ratio
Spirometry pre and post bronchodilator with a 12% improvement of FEV1
CXR shows hyperinflation
Methacholine challenge- causes bronchoconstriction
Asthma
Tx:
Bronchodilators
Beta2 agonists
Inhaled steroids
Asthma
SIDS occurs during sleep in what age group?
less than 1 yo
peaks 2-4 months
Exposure to cigarette smoke
Maternal age under 20
Prematurity and low birth weight
Prone sleeping position (“back is best”)
Soft bedding (no pillows, toys, blankets in crib)
Overheating
Bed sharing not recommended under 3 months old
Risk factors for SIDS
Siblings of SIDS victim increases risk _____ fold
5-6 fold
Room sharing
Breast feeding
Use of pacifier during sleep
Place infant on back to sleep
Methods to reduce SIDS
Hyaline membrane disease is a deficinecy in…
Surfactant
Asthma symptoms less than 2 days a week is what classification?
Intermittent
symptoms >2 times a week, but not daily
night time awakenings 3-4 times a month
use SABA >2 times a week, not daily
what classification of asthma?
Mild persistent asthma
Symptoms daily
Awaken >1 time a week but not daily
Use SABA daily
what classification of asthma?
Moderate persistent asthma
Symptoms daily throughout the day
Awaken at night ~7 times a week
Used SABA several times a day
what classification of asthma?
Severe persistent
Step 1 for asthma treatment?
SABA PRN (ie albuterol)
Step 2 asthma tx?
Low dose inhaled glucocorticoids
(step 3 would be medium dose inhaled glucocorticoids)
Failed therapy of asthma with medium dose inhaled glucocorticoids alone, what is the next time?
Add a LABA
______ maintains alveoli stability and inflation
*if deficient, no inspiratory pressure to inflate alveolar units, causing atelectasis
surfactant
What population is hyaline membrane disease seen in?
Premature infants! (under 37 weeks)
Signs of respiratory distress a few hours after birth
Cyanosis, hypoxemia
CXR shows ground glass appearance
Tx: Corticosteroids (during labor)
Surfactant
Hyaline membrane disease
What tx is used in Hyaline Membrane Dz because it induces the formation of surfactant in the fetal lung
Corticosteroids (give during labor)
S/S:
upper airway: stridor, choking, cough, cyanosis, not phonating
if complete obstruction, no cough or choking
lower airway: unilateral wheezing, recurrent pneumonia, cough
Dx with CXR
Foreign body aspiration
Should you do a blind finger sweep with finger in the oral cavity?
NO
Tx:
Infant: back blows, chest thrusts
Child: abdominal thrusts
Foreign body aspiration
