Respiratory Flashcards
What is the management for Bronchiolitis?
Immediate referral/admission if:
Apnoea, child looks seriously unwell, severe respiratory distress (grunting, subcostal recessions, RR > 70/min), central cyanosis, O2 sats <92% on air, inadequate oral fluid intake (<50% of usual volume)
Consider referral/admission if:
Respiratory rate >60/min, difficulty with breastfeeding or inadequate oral fluid intake (75% of usual volume), clinical dehydration
Respiratory mx:
1) Humidified oxygen if O2 <92%
2) CPAP if impending respiratory failure
3) Upper airway suction only if upper airway secretions are causing distress or feeding difficulties
4) Fluids - nasogastric/orogastric if not by mouth, IV if not tolerated or have impending respiratory failure
Extra: Infection control measures, Palivizumab - Ab against RSV
If mild:
Reassure - 2 wks is normal
Gets better itself
Advise hydration + paracetomal if child over 3 months old
Safety net A&E / call ambulance - severe respiratory distress/apnoea
NHS webpage on bronchiolitis/ leaflet
Match these RF to the right pathology:
Meconium staining
Prematurity
Caesarean section
Neonatal Respiratory Distress Syndrome (NRDS)
Tachypnoea of the newborn (TTN)
Aspiration pneumonia.
Meconium staining -> Aspiration pneumonia
Prematurity -> Neonatal Respiratory Distress Syndrome
Caesarean section -> Tachypnoea of the newborn
What is surfactant deficient lung disease AKA?
Respiratory distress syndrome and previously as hyaline membrane disease
What is the aetiology of surfactant deficient lung disease/ respiratory distress syndrome?
It is caused by insufficient surfactant production and structural immaturity of the lungs
What are the RF of surfactant deficient lung disease/ respiratory distress syndrome?
The risk of SDLD decreases with gestation
50% of infants born at 26-28 weeks
25% of infants born at 30-31 weeks
Other risk factors for SDLD include male sex diabetic mothers Caesarean section second born of premature twins
What are the clinical signs and symptoms of surfactant deficient lung disease?
Signs: tachypnoea, intercostal recession, expiratory grunting and cyanosis
Chest x-ray characteristically shows ‘ground-glass’ appearance with an indistinct heart border
What is the management of surfactant deficient lung disease/respiratory distress syndrome?
Management:
- prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
- oxygen
- assisted ventilation
- exogenous surfactant given via endotracheal tube
A child with a severe cough has a chest x ray, the results are as following:
PA view
subglottic narrowing
What does this represent?
This is the ‘steeple sign’ which confirms a diagnosis of croup
What are the hallmarks of life threatening asthma?
Peak exploratory flow rate is <33% predicted. Oxygen saturations <92%. Silent chest on auscultation. Weak or no respiratory effort. Hypotension. Exhaustion. Confusion.
What are some differential diagnoses of acute asthma?
Pneumothorax - sudden onset, chest pain, deviation of the trachea, unilateral chest signs
Anaphylaxis - sudden onset, antigen exposure
Inhalation of a foreign body - unilateral chest signs
Cardiac arrhythmia - chest pain or palpitations, tachycardia or changes in blood pressure.
Acute asthma - widespread wheeze, with exacerbation developing over minutes to hours and is confirmed by a reduced peak expiratory flow rate and FEV1 which improves with treatment.
What is the rate of chest compressions to breaths in a neonate?
3:1
What are the X-ray signs of transient tachypnoea of the newborn?
Hyperinflated lungs
Fluid within the right horizontal fissure
What are the X-ray signs of neonatal respiratory distress syndrome (surfactant deficiency disease)?
Ground glass lungs
Bell-shaped thorax
