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
