resp Flashcards
mx of sinusitis
refer if systemic infection, signs of orbital problems, neuro signs
If symptoms <10 days don’t give Abx
can use nasal saline
symptoms >10 days give intranasal corticosteroids (if child >12) consider back up Abx if nothing has changed in 7 days
how does whooping cough present
week of coryza followed by paroxysmal cough and then inspiratory whoop (cough can cause vomiting)
symptoms can go on for 3 months
Mx of whooping coufh
Admit if:
< 6 months
severe breathing difficulties (paroxysms, apnoea)
significant complications (seizures etc.)
If admission not needed give abx (MACROLIDE -clari)
Advice:
don’t go to school til 48 hours after Abx have been finished or 21 days after cough started if not treated
despite Abx they will have protracted non-infectious cough
mx of foreign body
Conscious: encourage coughing back manoeuvres removal of foreign body - rigid bronchoscopy if stridor asphyxia, radio opaque objects on CXR, hx of inhalation, reduced breath sounds in one area (if acute); if not do flex bronschoscopy surgery
Unsconscious:
secure airway
Causes of bronchiectasis
general: CF primary ciliary diskinesia imunodeficiency chronic aspiration
localised:
previous pneumonia
congenital lung abnormality
obstruction by foreign body
mx bronchiectasis
improve nutrition airway cleaning physio long term macrolide inhaled bronchodilator inhaled saline vaccination against strep + flu
acute exacerbation:
from sputum cultures
What is a serious complication of bronchiolitis
recurrent apnoea
When to admit a child with bronchiolitis
immediate:
apnoea, child looks generally unwell
severe resp distress (grunting, marked recession, RR >70), central cyanosis, 92 sat <92%
consider if:
RR>60
poor feeding and hydration
clinically dehydrated
mx bronchiolitis
Humidified O2 if sats <92%
CPAP if impending resp failure
upper airway suction if secretions
fluids (NG if not feeding)
what are the 3 types of wheeze
Viral induced
multiple trigger (this usually becomes asthma)
asthma
mx of viral episodic wheeze
- salbutamol inhaler w/ spacer
burst therapy - 10 puffs in an hour and then reassessed, if they’re ok they can go home - leukotriene antagonist /inhaled steroid
encourage parents to stop smoking
safety net:
return if symptoms don’t get better in 2 days
if no response after 10 puffs seek help
if they have symptoms in between viral illness they’re at increased risk of asthma
what does asthmatic wheeze sound like on auscultation
polyphonic
what is multiple trigger wheeze
wheeze triggered by different allergens
has a high likelihood of progressing to asthma
when to suspect multiple trigger wheeze/asthma
symptoms worse at nigh + early morning interval symptoms non-viral triggers FHx \+ve response to asthma treatment
Important questions to ask for asthma hx?
does it interfere with sleep
does it interfere with sport
how much school has been missed
Ix for asthma
< 5 years - clinical
> 5 years - spirometry (FV1/FVC), bronchodilator reversal, PEF variability for 2-4 weeks
mx asthma in children <5
NB - they will have a high index of suspicion
1. SABA reliever
go to stage 2 if they need it more than 3 times a week or they wake up in the middle of the night
2. paediatric moderate-dose ICS for 8 week trial
if symptoms resolve at 8 weeks stop ICS. If symptoms reoccur within 4 weeks restart ICS at low dose, if symptoms reoccur after 4 weeks repeat 8 week trial
3. ICS and LTRA
4. stop LTRA and refer to expert
mx asthma 5-16
- SABA
go to stage 2 if they need it more than 3 times a week or they wake up in the middle of the night - SABA + paediatric low dose ICS
- SABA + ICS + LRTA
- SABA + ICS + LABA
- switch ICS + LABA to MART (maintenance and reliever therapy) w/ paed ICS
- increase to moderate dose ICS + LABA w/ SABA reliever
- seek advice
what things are important to council in asthma
teach technique
personalised asthma action plan
routine immunisations
trigger avoidance
confirm adheremce
review technique and medications
Mx life threatening asthma
admit
high flow o2 if life threatening or O2 <94% (aim for 94-98)
SABA nebs - 5mg if >5yrs, 2.5mg if 2-5 years. ideally oxygen driven
ipratropium bromide nebs (with SABA)
magnesium sulphate nebs
corticosteroids (IM or oral)
2nd line:
IV salbutamol, IV aminophylline, IV MgSO4
mx moderate asthma exacerbation requiring hospitalisation
admit if worsening symptoms despite tx and/or if they’ve had previous serious attack
admit o2 if less than 94% SABA - pressurised inhaler with spacer. 1 puff every 30-60 seconds Ipratropium bromide corticosteroids
mild exacerbation
O2
Saba (SABA - pressurised inhaler with spacer. 1 puff every 30-60 seconds)
prednisolone (3-5 days)
Follow up for asthma attack
follow up within 2 days
review medications, technique etc.
When are croup symptoms worse
at night
if mild chest recession and stridor resolves at rest
Ranking of severity of croup
mild - seal like barking cough
moderate - barking cough + stridor and recession
severe - barking cough + stridor and recession + agitation/lethargy, RR>70
mx croup
admit anyone who’s moderate or above (put on oxygen and nebulised adrenaline if severe)
give single dose of oral dexa immediately to everyone
Safety net
return to hospital if continuous stridor or recession
call ambulance if pale, drowsy, can’t breather
Mx pneumonia
Refer to hospital admission immediately if: O2 <92% Grunting recession cyanosis RR >60 temp >38 in a child <3 months
If hospital admission not needed:
amoxicillin for 7-14 days
paracetamol for pyrexia
Features of cystic fibrosis through age
neonate, infant, young child, adolescents
neonate - meconium ileus
infant - jaundice, malabsorption and steatorrhea, failure to thrive, chest infection
young child - bronchiectasis, nasal polyps, rectal prolapse, sinusitis
adolescents - ABPA, DM, portal HTN, male sterility, pneumothorax, atypical chest infection (h.influenza and s.aureus when young, p.aeurginosa when older)
what are some examination findings of cystic fibrosis
hyperinflation due to air trapping
coarse inspiratory crackles
expiratory wheeze
finger clubbing
Diagnosis of CF
heel prick at birth
clinical manifestations + sweat test later
mx CF
delta F508 - lumacaftor
Pulmonary mx:
airway clearance techniques
mucoactive agents (rhDNase, hypertonic saline +rhDNase, mannitol dry powder)
infection mx:
flucloxacillin for staph a. prophylaxis
for pseudomonas inf:
acute infection - tx w/ abx as per local guidelines
chronic infection - nebulised colistemethate sodium + oral abx
GI mx:
high calorie diet
pancreatic enzyme replacement
H2 receptor antagonist or PPI if malabsorption persistent
