Pulomonary: Sx, Tx, Dx Flashcards
Stridor
Squeaky, whistlelike sound that results from turbulence between supraglottis and trachea
Extrathoracic obstruction Laryngomalacia
o CongenitalInspiratoryStridor “Noisy Breathing”
Worse in supine
Relieved when standing up or prone
Exacerbated by crying/feeding
o Softeningandweaknessoflaryngealcartilage
Collapses the airway o Dx
Laryngoscopy
Omgea shaped epiglottis
Collapse of the supraglottic structures w/ inspiration
Croup
Foreign body aspiration
Retropharyngeal Abscess
o Fever, drooling, dysphagia, neck pain, stridor
o Dx
CT
Vascular Rings
o PersistentStridor
o Branch of aortic arch encircles the trachea & esophagus
o Biphasic stridor and feeding difficulties
From tracheal or esophageal enacement o Improves w/ neck extension
Wheezing, rhonchi, and rales due to narrowing/congestion of bronchioles
o Expiratory Wheezing Intrathoracic obstruction Asthma Bronchiolitis o Crackles or Rales Parenchymal Disease Pneumonia Pulmonary edema o ↑ S2 ↑ Pulmonary Pressure
Tracheitis
o Bacterial
S. aureus most common cause Hx of recent URI
Previous viral laryngotracheobronchitis (croup, inspiratory stridor)
Follows w/ acute elevation in temperature, trouble breathing, change
to biphasic stridor (expiratory & inspiratory) Brassy cough, high fever, respiratory distress
Tx for croup (mist & racemic epinephrine) don’t help
Tx
Secure airway (intubation) IVABx
Epiglottitis
o Acute inflammation and edema o Mostcommon2-7y/o o Causes HIB Blood culture will be + 90% Unvaccinated typically GAS (β Hemolytic), Moraxella o Sx Rapid upper airway obstruction Can cause Resp Arrest High Fever (~104°) Muffled Speech Inspiratroy stridor Dysphagia w/ drooling Sitting forward in tripod position w/ neck hyper extension o Signs “Thumbprint” on lateral xray Cherry Red epiglottis o Tx 2nd/3rd Generation Cephalosporin Rifampin prophylaxis for non-immunized if HIB 1st step Have sterile environment and skilled personal for nasotrachealintubation
Croup (Laryngotracheobronchitis)
o Inflammation/Edema of Subglottic Larynx, Trachea, &Bronchi
o Types
Viral
Most common, 3m to 3y, Late Fall/Winter
Spasmodic
Preschool children, Secondary to Hypersensitivity
o Viral Croup
Causes
Parainfluenza (most), RSV, Adenovirus, Influenza Viral Prodrome for 2-3d (rhinorrhea, low grade fever)
Followed by inspiratory stridor (means upper airway/extrathoracic) & cough, fever
o BarkyCough Stridor worsens at night
AP XR “Steeple Sign” (Subglottic Narrowing) o SpasmodicCroup
Acute onset, mainly at night
Recurs & Resolves w/out Tx
o Tx
NO ALBUTEROL (can worsen) If stridor @ rest
Systemic Corticosteroids
o Dexamethasone(↓edema)
O2 w/ humidified air (Cool Mist/Air) Resp Distress
Racemic Epinephrine Aerosol
o Always try trial of epi before intubation o α:Vasoconstriction»↓Edema
o β: Smooth muscle relaxation of air way
Asthma
o Decreased Expiratory Flow
o Sx
Nocturnal Cough (#1), wheezing (usually expiratory, really severe if
inspiratory), dyspnea
o AsthmaTriadFamilyHx
Eczema (atopic), Allergic Rhinitis, and Asthma
o Classification&Tx
Mild Intermittent
2 Daytime per week
1 night time per week
Options
o Medium-dose corticosteroids + short acting β-agonist
o Low-dosecorticosteroidsandalong-actingβ-agonist
Severe persistent
Continual Sx?
High-dose inhaled steroids + as long-acting β-agonists + oral steroids
o Tx
If oral thrush from inhaled steroids, rinse mouth after If signs of impeding respiratory failure
∆MS, silent chest (not moving air bilaterally), hypoxemia (low pO2), CO2 retention (acidosis)
Intubation w/ mechanical ventilation
Bronchiolitis
o Inflammation/obstruction of the bronchioles by viral infection
o Most Common Lower Respiratory Infection of First 2y
o NovtoApril(winter)
o Significant in those w/ chronic lung disease, CHD, prematurity
o Causes
RSV (most), Parainfluenza, Adenovirus, Rhinovirus, Influenza
o Sx
Initial gradual URT Sx
Rhinorrhea, nasal congestion, fever, cough Progression
Tachypnea
Scattered fine rales /coarse breath sounds(crackles), wheezing
Palpable liver & spleen
o From Hyperinflation
Hypoxemia (respiratory failure) & Apnea (esp.
Pneumonia
o Infection & Inflammation of the Lung Parenchyma
o Cough, fever, tachypena, abnormal chest auscultation
Rales
Heard in Pneumonia & CHF
Wet or Crackly inspiratory breath sounds o Duetoalveolarfluid/debris
Wheezing
o Causes
0 to 3m
Congenital Infections
Intrapartum (First few days of life)
o GBS (Most), Gram – Rods (E. coli), Listeria o HSV
IV Acyclovir
Postpartum
o RSV
Afebrile Pneumonitis
o Chlamydia trachomatis, Ureaplasma urealyticum Tx
o Ampicillin+Gentamicin(orCefotaxime) Viruses
3mto5y
o Adenovirus, influenza, parainfluenza, RSV (Not after 2y)
Bacteria
o Streppneumoniae
> 6y
Mycoplasma &Chlamydia (Walking Pneumonias)
Viruses (Not RSV)
Strep pneumoniae
Types of Pneumonia
Viral Pneumonia
URI Sx
o Rhinorrhea, nasal congestion, fever, cough
Interstitial infiltrates
WBC 20,000 (nΦ)
Complications
o Lungabscess(empyema)
Purulent infection in the pleural space
Typically w/ S. aureus, S. pneumoniae, S. pyogenes ↓ breath sounds on affected side
On CXR: Near complete whiteout
Tx
Vancomycin bc of varying resistances o TensionPneumothorax
Esp. S. aureus
Rupture of alveoli into pleural space from bacterial
toxins
Acute worsening
Tx
Insert needle into 2nd/3rd intercostals space at midclavicular line
Tx
o ABx
Chlamydia trachmatis
Most common cause of Afebrile Pneumonia 1-3m Staccato Type Cough, dyspnea, NO Fever, Wheezing, rales/rhonchi 50% Hx of Conjunctivitis @ birth Dx o Erythromycin, CXR w/ Hyper inflation & Interstitial infiltrates (ground glass appearance: fine reticular opacities) o DirectFluorescentAb o Eosinophilia Tx o Erythromycin
Mycoplasma Pneumoniae
Older children & adolescents
Widespread rales & rhonchi
o Physical exam is worse than would expect by history CXR
o Interstitialinfiltrates Dx
o + Cold Agglutinins, ↑IgM Mycoplasma Titer Tx
o Erythromycin or Azithromycin
Same as Chlamydia trachomatis in Afebrile Pneumonia
Pertussis
o WhoopingCough
o Immunization@12m
o
Allergic Rhinitis
o Can also cause Nasal Polyps from chronic inflammation
o Headache and Congestion, but not fever/purulent discharge (AcuteRhinitis)
o SeasonalVariability
Cystic Fibrosis
o Sx/Signs
Cough that starts off dry/hacking but progresses to productive
Meconium Ileus @ Birth
Bilious vomiting
Inspissated meconium consistency
If suspected, get XR first bc can identify air in peritoneum, a surgical
emergency
o Next contrast enema
Distal Colon will be small
Microcolon
Hyperosmolar enema may be therapeutic If fails, surgery
FTT, progressive Resp Insufficiency, Pancreatic Insufficiency (fat malabsorption → steatorrhea /foul smelling)
Gray stools
Fat vitamin deficiency
Nasal Polyps w/ chronic sinusitis
Headache, fever, cough (from postnasal drip), purulent discharge
Tender sinuses, unable smell, snoring
Opacification on CT of all sinuses by 8 y/o
↓ Expiratory Flow Rate (Consistent w/ obstructive 1st)
↓ Lung Vol. (Consistent w/ Restriction 2nd)
Rectal Prolapse
Jaundice, Biliary Cirrhosis
Recurrent Pneumonia
1st get S. aureus
2nd get P. aeruginosa (Transition around 20 y/o)
Hypoxemia
Digital Clubbing Hyponatremia
Increased salt loss in sweat
o Dx
Abnormal Sweat Chloride Test
o Pancreatic enzymere placement and fat vitamin supplements
Chronic Lung Disease
o O2 Dependent past 28d
o Most common in Prematures born w/ARDS
o Follows Acute Lung Trauma
Barotrauma from Mechanical Ventilation, Meconium Aspiration Syndrome, Infections
Followed by secondary lung injury (oxidants & proteases) Healing of lung tissue is abnormal
Both Restrictive (from tissue fibrosis) & Obstructive (from dysplastic narrowed airways) Lung Disease
o S/Sx
Diminished Oxygenation (↓ PaO2)
Hypercarbia (↑PaCO2)
Intermittent Tachypnea, wheezing, respiratory distress
Frequent Infection
