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Resp Flashcards

1
Q

Signs of respiratory distress in children (7)

A
  • Tachypnoeic for age
  • Using accessory muscle
  • Intercostal recession, sternal recession, tracheal tug, subcostal recession
  • Head bobbing
  • Nasal flaring
  • Pursed lips
  • Grunting
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2
Q

What is neonatal RDS?

A

Neonatal Respiratory Distress Syndrome
• Immature lungs due to prematurity
• Surfactant deficiency (decreased innate immune response, airway collapse)
• Incidence & severity inversely proportional with gestational age of infant
• Bell shaped thorax on x-ray

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3
Q

Risk factors for neonatal RDS

A
  • Prematurity (!)
  • Maternal diabetes
  • Caesarean delivery
  • Asphyxia
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4
Q

Treatment of neonatal RDS

A
  • Antenatal steroid administration (enhances pulmonary maturity)
  • Surfactant administration
  • Appropriate resuscitation (placental transfusion, CPAP for alveolar recruitment)
  • Supportive fluids, electrolyte management, nutrition
  • Prophylactic FLUCONAZOLE
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5
Q

Complications of neonatal RDS

A
  • Septicaemia
  • Bronchopulmonary dysplasia
  • Patent ductus arteriosus
  • Pulmonary haemorrhage
  • Apnoea, bradycardia (ABC)
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6
Q

What is neonatal chronic lung disease also called?

A

Bronchopulmonary dysplasia

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7
Q

Definition of chronic lung disease?

A

= Prolonged need for ventilatory support beyond 36 weeks post conceptual age
=Prolonged need to O2 beyond 28 days with abnormal CXR

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8
Q

What is the pathophysiology of neonatal chronic lung disease?

A
  • Airway epithelial necrosis
  • Squamous metaplasia
  • Organisation of hyaline membranes
  • “white out” lung fibrosis
  • Fewer and larger alveoli (emphysematous change)
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9
Q

Risk factors for neonatal chronic lung disease?

A
  • Gestational age
  • Low birth weight
  • Male gender
  • Need for resus after birth
  • Ventilation
  • O2 toxicity
  • RDS
  • Infection
  • ILD (interstitial lung disease)
  • Pulmonary hypertension
  • Cystic fibrosis
  • Neuromuscular disease
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10
Q

Complications of neonatal chronic lung disease?

A
  • Persistent O2 & ventilation requirements
  • Increased hospital stay/need for home O2
  • Pulmonary hypertension
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11
Q

Xray findings of neonatal chronic lung disease?

A
  • Indistinguishable from RDS
  • Marked radio opacity of lungs
  • Cystic/bubbly pattern of opacity
  • Hyperexpansion, linear streaks & emphysema +/- cardiomegaly
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12
Q

What can be done to prevent neonatal chronic lung disease?

A
  • Antenatal steroids when preterm birth is anticipated
  • Avoid excessive O2 & ventilation
  • Give surfactant early
  • Optimise ventilation
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13
Q

Treatment of neonatal chronic lung disease

A
  • Post natal steroids (low dose, DART, avoid in 1st week of life unless life threatening
  • Nitric oxide?
  • O2
  • Avoid fluid overload +/- diuretics
  • Use pressure ventilation rather than volume
  • Vitamin A
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14
Q

What is asthma?

A

Chronic inflammatory obstructive airway disease characterised by reversible airway obstruction

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15
Q

What causes asthma?

A
  • Bronchial muscle contraction (triggered by cold air, smoking, allergies, B-blockers, NSAIDs, infection)
  • Mucosal swelling & inflammation (mast cells and basophils releasing inflammatory mediators)
  • Increased mucus production
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16
Q

Symptoms and signs of asthma

A
  • Dyspnoea and chest tightness (decreased FEV1/FVC ratio)
  • Wheeze
  • Cough (often night/early morning)
  • Sputum
  • Tachypnoea
  • Audible wheeze and polyphonic wheeze
  • Hyperinflated chest (hyper-resonant percussion)
  • Widespread reduced air entry noises
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17
Q

What happens during an acute attack of asthma?

A
  • Unable to complete sentences
  • Pulse >110bpm
  • Resp rate>25/min w/accessory muscle use
  • Peak expiratory flow 35-50% predicted
18
Q

What would indicate life threatening asthma?

A

Bradycardia, no air entry, cyanosis, confusion!!

19
Q

Treatment of acute severe asthma

A
  • O2
  • Nebulised B2 agonist (salbutamol)
  • Oral prednisolone/IV hydrocortisone
  • Add Ipratropium (atrovent) and magnesium if no improvement
20
Q

Name 3 types of relievers for asthma and an example of each

A

ß2 agonists: salbutamol
Methylxanthines: aminophylline
Antimuscarinics: ipratropium

21
Q

Name 5 types of preventers in asthma and an example of each

A 
Corticosteroids: beclametasone
Cromones: sodium cromoglycate
Anti-leukotrienes: montelukast
PDE4 inhibitors: roflumilast
MgSO4
22
Q

How do salmeterol and formoterol gain their long lasting effects?

A

SALMETEROL - flexible tail

FORMOTEROL- dissolves in plasma membrane

23
Q

Action of ß2 agonists

A

Acts on ß2 adrenoreceptors
Inhibits mediator release from mast cells and monocytes
Broncodilates

24
Q

SE of ß2 agonists

A

Tachycardia, tremor, lactic acidosis

Hypokalaemia, hyperglycaemia

25
Q

Action of methylxanthines

A

Asthma reliever
• Hyperpolarises muscle cells -> bronchodilation
• Increased cilia action
• Decreased muscle fatigue in chest and diaphragm -> improved ventilation
• Decreased histamine & leukotriene release

26
Q

SE of methylxanthines

A

Similar to coffee

GI upset, headache, insomnia

27
Q

SE of antimuscarinics

A

Dry mouth, constipation

28
Q

Action of corticostroids in asthma

A
  • Suppresses inflammation and immune response
  • Decreased oedema and inflammatory cell activation and recruitment
  • Decreased leukotrienes
29
Q

SE of inhaled corticosteroids

A

Oral candidiasis, hoarseness

30
Q

Action of cromones

A

Mast cell stabilisation
Decreased eosinophil activation
Decreased IgE

31
Q

Name the steps involved in asthma medication

A

1) Inhaled SABA (salbutamol) when needed/Ipratropium if intolerant
2) Regular inhaled GCS (beclametasone)
3) Inhaled GCS + inhaled LABA (salmeterol)
4) High dose inhaled GCS + anti-leukotriene (montelukast) + oral theophylline +/- LABA
5) Oral GCS

32
Q

What is bronchiolitis

A

An acute inflammatory injury of the bronchioles that is usually caused by a viral infection
Affects those less than 2 (tiny airways)
Peak age 3-6 months

33
Q

Causes of bronchioloitis

A

RSV, flu, paraflu, rhinovirus, adenovirus (highly infectious)

34
Q

Pathophysiology of bronchiolitis

A
  • Lower respiratory tract viral infection
  • Increased mucus secretion
  • Bronchial obstruction and constriction
  • Alveolar cell death, mucus debris, viral invasion
  • Air trapping
  • Atelectasis
  • Reduced ventilation that leads to ventilation-perfusion mismatch
  • Laboured breathing
35
Q

Name 11 risk factors for bronchiolitis

A
  • Age less than 3 months
  • Low birth weight
  • Gestational age (esp <29weeks)
  • Lower socioeconomic
  • Crowded living conditions, childcare centre attendance, presence of an older sibling or a combination
  • Parental smoking
  • Chronic lung disease
  • Severe congenital or acquired neurologic disease
  • Haemodynamically significant congenital heart disease (CHD) with pulmonary hypertension
  • Congenital or acquired immune deficiency diseases
  • Airway anomalies
36
Q

Signs of bronciolitis

A
  • Tachypnea
  • Tachycardia
  • Fever (38-39°C)
  • Retractions
  • Fine rales (47%)
  • Diffuse, fine wheezing
  • Otitis media
  • Profuse coryza
  • Fine rales, wheezes
37
Q

Investigations for an infant presenting with bronchiolitis symptoms

A
  • Viral swab
  • ABG
  • WCC & CRP
  • CXR
  • Septic screen
  • Pulse oximetry (90% lower limit for hospitalisation)
38
Q

7 differential diagnoses to bronchiolitis

A
  • Bronchomalacia
  • Cardiac disease/congenital heart disease
  • Congenital lobar emphysema
  • Congenital structural airway anomaly
  • Constrictive bronchiolitis
  • GORD
  • Tracheal ring/vascular ring
39
Q

Treatment of bronchiolits

A
  • Bronchiolitis is an infectious, self-limited disease (7-10days)
  • Supportive care (nutrition may need to be NG if tachypnoeic-> aspiration)
  • Oxygenation (+/- CPAP)
  • Nebulised hypertonic saline & saline drops and suctioning
  • Hydration
  • Fever control
  • Avoidance of exposure to tobacco smoke or other irritants
  • Methods for limiting transmission (eg, handwashing and avoiding childcare centres while ill)
40
Q

When is a PICU admission required for bronchiolitis

A
  • Worsening hypoxemia or hypercapnia
  • Worsening respiratory distress
  • Persistent oxygen desaturation and/or severe cyanosis in spite of adequate oxygen delivery
  • Apnoea
  • Acidosis
  • Extra-pulmonary symptoms
  • Worsening mental status
  • Unclear aetiology of symptoms
41
Q

Complications of bronchiolitis

A
  • Acute respiratory distress syndrome (ARDS)
  • Bronchiolitis obliterans
  • Congestive heart failure
  • Secondary infection
  • Myocarditis
  • Arrhythmias
  • Chronic lung disease
42
Q

Treatment of severe viral croup

A 
Humidified warmed air
Oxygen
Intubation
Steroids
Nebulised adrenaline

Paeds (14 decks)

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