Pulmonology Flashcards
What are the differential diagnoses of upper acute airway obstruction
- Laryngotracheobronchitis (Croup)
- Laryngitis
- Spasmodic croup
- Epiglottitis
- Membranous croup or bacterial tracheitis
- Retropharyngeal abscess
- Foreign body
- Angioedema or allergic reaction
- Peritonsillar abscess
- Laryngeal papillomatosis
Age of onset of laryngotracheobronchitis or croup
6months-3 years
Age of onset of laryngitis
5yr - teens
Age of onset of spasmodic croup
3mos - 3 years
Age of onset of epiglotittis
2yr - 6 yr
Age of onset of bacterial tracheitis
Any age (3-10 yr)
Etiologic agent croup
PARAINFLUENZA virus
Influenza virus
RSV
Rarely mycoplasma, measles, adenovirus
Etiologic agent Laryngitis
SAme with croup:
PARAINFLUENZA virus
Influenza virus
RSV
Rarely Mycp;asma, Measles, adenovirus
Etiologic agent Spasmodic croup
usually non infectious’
Hib
Etiologic agent Epiglottitis
Respiratory virus
Etiologic agent bacterial tracheitis
Trachea with secondary bacterial infection:
S aureus, M. Catarrhalis
Prodrome Croup
FEver, URI
Prodrome Laryngitis
URI, sore throat at night
Prodrome Spasmodic croup
Sudden onset short episodes
Prodrome/ Symptoms Epiglotittis
Rapid dramatic onset, potentially lethal course of
High fever sore throat, dyspnea, and progressive airway obstruction
RARELY Stridor
Muffled voice
TRIPOD SITTING
Drooling, Agitated toxic
SEVERE marking
Thumb sign on xray
Epiglottitis
Management of Epiglottitis
- ABC’s Secure airways top priority!
Endotracheal/Laryngeal intubation or tracheostomy (if totally obstructed)
-intubated for 2-3 days because the response to antibiotics is usually rapid
-Labs: CBC with PC, Blood, Epiglottic surface, and even CSF. - ANtibiotics : Ceftriaxone, Cefipime or meropenem at least 10 days (nelson)
(In PIDSP: Ceftriaxone or AMPISUL x 7-10 days) - use of steroids is controversial and not recommended
- Rifampicin prophylaxis 20mkday max 600mg x 4 days on kids <4 y/o or <12 mos who are immunocompromised/incomplete vaccination
4 year old male presents with malaise, sore throat, anorexia, and low-grade fever. Within 2 to 3 days but angel examination reveals the typical gray white membrane which can vary in size from covering a small patch on the tonsils to covering most of the soft palate the membrane he said he went to the tissue and forcible attempts to remove it can cause bleeding. What is the diagnosis based on Symptoms and physical examination
Diphtheria
Management of Croup
Racemic epinephrine nebulization
Oral corticosteroids In viral group as well established: Single dose oral dexamethasone of 0.6 mg per kilogram
Antibiotics not indicated
SUbglottic narrowing/steeple sign
Croup
Accumulation of extra pulmonary air within the chest and most commonly from leakage of air from the lung it can acquire without trauma or underlying lung disease
Pneumothorax
Pneumothorax is classified as complicated or simple/non-complicated. How do you differentiate the two?
Is simple pneumothorax intrapleural pressure is atmospheric in the lung collapses up to 30%.
In tension/complicated pneumothorax continuing leak increases positive pressure in the pleural space compressing mediastinal structures (shifts AWAY from the pneumothorax side)
Diagnosis of pneumothorax
X-ray
Management of pneumothorax
- less than 5% done with our acts in a normal child may resolve without treatment usually within one week.
- If pneumothorax is recurrent, secondary, or under tension, or there is more than 5% collapse, chest tube drainage is necessary
- If recurrent: Chemical pleurodesis (talc, doxicycline or iodopovidone
