Resp Flashcards
Management of croup
- oral dexamethasone regardless of severity
- admit if mod or above
- nebulised adrenaline + oxygen via face mask if severe obstruction
Presentation of croup
- initial coryza and fever
- BARKING seal-like cough, often worse at night
- hoarseness
- harsh stridor
Presentation of epiglottitis
- very acute onset
- may be drooling
- high fever, very ill, look toxic
- PAIN - troubling speaking/swallowing
- soft stridor
- rapidly increasing respiratory difficulty
Management of epiglottitis
- call for senior help: anaesthetist, paeds, ENT
- transfer to ITU/anaesthetic room
- intubate in controlled setting under GA (or tracheostomy if not possible)
- once airway secured: blood culture + IV Abx (e.g. cefuroxime)
Management of bacterial tracheitis (pseudomembranous croup)
IV Abx +/- intubation and ventilation if required
How does bacterial tracheitis (pseudomembranous croup) present
- similar to epiglottitis
- high fever, very il
- rapidly progressive obstruction with copious thick airway secretions
Bronchiolitis age range
most aged 1-9 months
Management of bronchiolitis
supportive +/- humidified oxygen +/- CPAP, NG/IV feeds
What is palivizumab (Synagis) for?
Mab to RSV - passive immunity against bronchiolitis
- given as monthly IM injection during high risk period for high risk children
What is asthma worse?
night and early morning
What improvement in peak flow or FEV1 with bronchodilators signifies reversibility?
> /=12%
What is 1st choice add-on therapy after SABA and low-dose ICS for children <5y?
LTRA (montelukast PO)
What is 1st choice add-on therapy after SABA and low-dose ICS for children >5y?
LABA e.g. salmeterol INH
Incidence of CF and carrier rate?
1 in 2500 live births, 1 in 25 are carriers
Diagnosis of CF
- Heelprick test - raised IRT
- Sweat test: chloride 60-125mml/l (normal 10-40)
- Screened for common CF gene mutations
Which bacteria cause initial infections in CF?
Staph aureus, Haemophilus influenza
Which bacteria cause later infections in CF?
Pseudomonas aerioginosa, Burkholderia
Diagnosis of pancreatic insufficiency (e.g. in CF)
low faecal elastase
What continuous prophylactic Abx should patients with CF be on?
flucloxacillin usually
Presentation of whooping cough
- 1 week coryza (catarrhal phase)
- paroxysmal/spasmodic cough +/- ‘whoop’ at the end, hard to breathe
- often worse at night
- may cause vomiting
- goes red/blue in face during cough, mucus from nose and mouth
- may get epistaxis/subconjunctival haemorrhages
- apnoea more common than whoop in infants
- paroxysmal phase may last up to 3 months
- symptoms gradually decrease (convalescent phase), may persist for months
Who gets vaccinated against whooping cough?
- children as part of 6 in 1 and 4 in 1 vaccines
- pregnant women
How does obstructive sleep apnoea present in children?
- excessive daytime sleepiness or hyperactivity
- learning and behaviour problems
- faltering growth
- if severe: pulmonary HTN
What is obstructive sleep apnoea in children usually due to?
upper airway obstruction secondary to adenotonsillar hypertrophy
Ix of obstructive sleep apnoea in children
- overnight pulse oximetry: normal = severe physical consequences unlikely
- polysomnography if more complex (monitors various things during sleep)
- sometimes more details electrophysiological assessment
Management of obstructive sleep apnoea/sleep-related breathing disorders in children
- if adenotonsillar hypertrophy: adenotonsillectomy
- if other sleep-related breathing disorders: CPAP or BiPAP at night
