Pulmonary Flashcards
Describe the sound of rales/crackles. When do you predominantly hear it?
Scratchy, bubbly
Inspiration
What mainly causes rales/crackles in peds?
Bronchiolititis
Describes wheezes
continuous, high pitches
Expiration
Describe Rhonchi
continuous, low pitched
Snoring
Causes for Rhonchi
- Pneumonia
2. Cystic Fibrosis
Describe Stridor
High pitch, harsh
Inspiration
What is the main cause for stridor?
Croup
si/sx’s of Viral Croup (laryngotrachobronchitis)
- Inspiratory stridor
- Hoarseness
- Cough: barking, “seal-like”
What is the #1 cause for viral croup? other MC?
#1=Parainfluenza Virus Type 1 Other= RSV
What are the 5 components of the Westley Croup Score?
- Level of consciousness
- Cyanosis
- Stridor
- Air entry
- Retractions
List the signs of imminent respiratory failure
- Fatigue and listlessness
- Marked retractions
- Decreased/absent BS
- Depressed LOC
- Tachycardia out of proportion to fever
- Cyanosis/pallor
Based on the Westley Croup Score, what is considered Mild Croup? Treatment plan?
Score= <2
- Supportive tx
- Cool mist
Based on the Westley Croup Score, what is considered Moderate Croup? Treatment plan?
Score=3-7
- Corticosteroids: Dexamethasone IM/IV
- Nebulized racemic Epi
Radiographic findings in Viral Croup
Steeple Sign
Epiglottitis etiology
Hib: Haemophilus influenza type b
Epiglottitis si/sx’s
3 D’s + Tri-pod posturing:
- Dysphagia
- Drooling
- Distres
Epiglottitis radiograph findings
“Thumb sign”
Epiglottitis treatment
- Airway supports! ET tube
2. Abx: 3rd generation Cephalosporing + Vancomycin
What age is Bronchiolitis MC in?
Age <2
What is the #1 cause of Bronchiolitis?
RSV
Si/sx’s in Bronchiolitis
- Tachypnea, labored breathing
- Cough
- Hypoxia
Lung exam findins in Bronchiolitis?
Wheezing
Crackles
Bronchiolitis treatment
- Oxygen
- Maintain hydration
- Nasal suctioning
What is the most important cause of LRTI in children <1 yr
Respiratory Syncytial Virus: RSV
RSV si/sx’s
- Crackles
- Prolonged expiration wheezing
- Retractions
- MUCUS!!!
CXR findings in RSV
Hyperinflation
Peribronchial thickening
RSV diagnosis
Rapid assay (nasal swab/wash)
When would you give Ribavirin for tx of RSV?
ONLY if immunocompromised
What is the MCC of respiratory distress in preterm infants?
Respiratory Distress Syndrome (RDS)= “Hyaline Membrane Disease”
Etiology of Respiratory Distress Syndrome (RDS)
Deficiency of Surfactant production + surfactant inactivation by protein leak into airspaces
CXR findings in RDS
“Ground-glass appearance”= Atelectasis
RDS treatment
- Oxygen, nasal CPAP, intubation
- Surfactant replacement
- Steroids
When do you admit for pneumonia?
<3-6 mos. old
Hypoxemic
Pneumonia abx treatment
Amoxicillin 90 mg/kg per day
If atypical pneumonia suspected, abx treatment?
Azithromycin
Pertussis (whooping cough) etiology
Bordatella pertussis
Phase 1 of pertussis
1-2 weeks:
URI sx’s
Fever
Phase 2 of pertussis
2-6 weeks:
Persistent paroxysmal cough
Inspiratory “whooping” postussive emesis
Phase 3 of pertussis
Weeks to Months:
Cough gradually resolves
Complications of pertussis
- Hypoxia
- Apnea
- Pneumonia
- Seizures
Pertussis treatment
Macrolides
TMP-SMX
*Tx everyone in the household