Resp - chest infection Flashcards
What are the chest findings in bronchiolitis?
Laboured breathing
Hyperinflated chest
Chest recession
Hyperresonant
Fine crackles in all zones. Possible wheeze
Which virus most often causes bronchiolitis?
RSV. It can however also cause croup, pneumonia or a common cold.
Other viruses are human metapneumovirus, parainfluenza virus, rhinovirus, adenovirus, influenza virus, and Mycoplasma pneumoniae
At which ages is bronchilitis most present?
1-9 months.
Rare after 1 year
What is the natural history of bronchiolitis?
Coryzal symptoms preceding a dry cough.
Feeding difficulty due to dyspnoea.
Increased risk of severe disease if prematurely born and develop bronchopulmonary dysplasia, or CF or congenital heart disease are at higher risk of developing severe bronchiolitis
What are the examination findings of bronchiolitis
Sharp, dry cough
Tachypnoea
Subcostal and intercostal recession
Hyperinflation of the chest (prominent sternum, liver displaced downwards)
Fine, end-inspiratory crackles
High-pitched wheezes
Tachycardia
Cyanosis or pallor
What is the management of acute bronchiolitis
Supportive
Humidified oxygen via nasal cannulae.
Concentration determined by pulse oximetry.
Monitor for apnoea.
Fluids may need to be given NGT or IV
A small percentage require assisted ventilation in the form of nasal or facemask CPAP or full ventilation
What is the prognosis of bronchiolitis?
2 week disease, most recover by the end of 2 weeks
Peak at days 4,5,6
Up to 50% can have recurrent cough and wheeze
What are the chest signs of pneumonia?
Inspection
Reduced movement on affected side.
Rapid, shallow breaths.
Percussion - dull
Auscultation - bronchial breathing, crackles
An infant may not have any abnormal signs on auscultation
Which (birth) factors predispose infants to pneumonia? What is the treatment?
Low birth weight
Chorioamnionitis
Prolonged rupture of membranes
Broad spectrum antibiotics until infection screen results available
What are general risk factors for pneumonia in all children?
Low birth weight Young age Not breast-fed Vit A deficiency Overcrowding
What are the general causative organisms of pneumonia?
Viral more likely in infants
Bacterial more likely in older children
In clinical practice, it is difficult to distinguish
Which are the likely causative organisms of pneumonia in a newborn?
Group B strep
Gram -ve enterococci
Which are the likely causative organisms of pneumonia in infants and young children?
RSV
Streptococcus pneumoniae
Haemophilus influenzae
Bordetella pertussis
Chlamydia trachomatis
Staph aureus is rare, but very serious!
Which are the likely causative organisms of pneumonia in children >5 years of age?
Mycoplasma pneumoniae
Streptococcus pneumoniae
Chlamydia pneumonia
Which causative organism should be considered for children of all ages?
Mycobacterium tuberculosis
Which features of the history point towards pneumonia?
Fever
Difficulty breathing
Cough, lethargy, poor feeding, unwell
Which feature in the history suggests bacterial pneumonia?
Localised chest, abdominal or neck pain
Indicates pleural irritation
What are the features of pneumonia on examination?
Tachypnoea (best marker)
Nasal flaring
Chest indrawing
Which is the only time a CXR can differentiate bacterial from viral pneumonia?
In the presence of classic lobar pneumonia - Streptococcus pneumoniae
When should a child with pneumonia be admitted to the hospital?
Most can be managed at home.
Admit, if O2 sats <93%, severe tachypnoea, difficulty breathing, grunting, apnoea, not feeding or family unable to provide appropriate care
What is the antibiotic choice for newborns with pneumonia?
iv broad spectrum antibiotics
What is the antibiotic choice for older infants with pneumonia?
Oral amoxicillin
Broader spectrum antibiotics, such as co-amoxiclav are reserved for the complicated or unresponsive
What is the antibiotic choice for children >5 with pneumonia?
Amoxicillin or an oral macrolide (eg. erythromycin)
How is empyema in pneumonia managed?
Needs drainage.
Chest drain with or without the placement of fibrinolytic agents in intrapleural space (eg. urokinase)
