Respiratory Flashcards
Define bronchiolitis
Inflammation and infection of the bronchioles. Generally considered to occur in children under 1
What is the most common causative organism in bronchiolitis
Respiratory syncytial virus (RSV)
Presentation of bronchiolitis
Coryzal symptoms
Respiratory disetress
Dyspnoea
Tachypnoea
Poor feeding
Mild fever
Apnoea
Wheeze
Crackles
Clinical signs of respiratory distress
Raised resp rate
Use of accessory muscles - sternocleidomastoid, abdominal, intercostal
Intercostal and subcostal recession
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal noises - wheezing, grunting, stridor
Reasons for admission in bronchiolitis
<3 months
Pre-existing condition - prematurity, Downs or cystic fibrosis
50-75% reduction in milk intake
Clinical dehydration
Resp rate >70
O2 <92
Signs of moderate to severe respiratory distress
Apnoeas
Parents not confident to manage at home
Management of bronchiolitis
Supportive
Adequate intake - NG, IV, frequent feed
Saline nasal drops, suctioning,
Supplementary O1
Ventilatory support
Prevention in those at high risk (prem or congenital heart disease) - palivizumab
Define viral induced wheeze
Acute wheezy illness caused by viral infection. Caused by inflammation of the small airways leading to swelling and constriction,
Presentation of viral induced wheeze
Viral illness - fever, cough, coryza
Shortness of breath
Signs of respiratory distress
Expiratory wheeze through out chest
Management of viral induced wheeze
Same as acute asthma
O2
Bronchodilators - salbutamol, ipratropium, magnesium,
Steroids
Antibiotic if bacterial
Define acute asthma
Rapid deterioration of asthma symptoms - triggered by infection, exercise or cold weather.
Presentation of acute asthma
Progressively worsening shortness of breath
Signs of respiratory distress
Fast resp rate
Expiratory wheeze throughout chest
Chest sounds “tight” with reduced air entry
Parameters for moderate asthma exacerbation
Peak flow >50% predicted
Normal speech
No features of severe or life threatening asthma exacerbation
Parameters for severe asthma exacerbation
Peak flow <50 % predicted
Saturations <92
Unable to complete sentences
Signs of respiratory distress
Resp rate > 40 (1-5 years) >30 (>5)
Heary rate >140 (1-5) >125 (>5)
Parameters for life threatening asthma exacerbation
Peak flow <33%
Saturations <92%
Exhaustion and poor respiratory effort
Hypotension
Silent chest
Cyanosis
Altered conciousness/confusion
Management of acute asthma
O2
Bronchodilators
Steroids
Antibiotics
Parameters for discharge in acute asthma
6 puff 4 hourly
Once steroids complete
Safety net
Define chronic asthma
Chronic inflammatory airway disease leading to variable airway obstruction -
Presentation of asthma
Episodic symptoms - exacerbations
Diurnal variability - worse at night or early morning
Dry cough
Triggers
History of atopy - eczema, hayfever and food allergies
FH of asthma
Bilateral wheeze
Improvement with bronchodilators
Typical triggers of asthma
Dust
Animals
Cold air
Exercise
Smoke
Food allergens
Investigations of asthma
Clinical trial of bronchodilator
Spirometry with bronchodilator reversibility
Fractional exhaled nitric oxide
Peak flow diary
Management of asthma
- SABA
- ICS
- leukotriene receptor antagonist
Refer
Define pneumonia
Infection of the lung tissue - seen as consolidation on chest xray
Presentation of pneumonia
Cough
High fever
Tachypnoea
Tachycardia
Increased work of breathing
Lethargy
Delirium
Clinical signs of pneumonia
Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever
Confusion
Bronchial breath sounds
Focal coarse crackles
Dullness to percussion
Common causes of pneumonia
Streptococcus pneumonia
Group A strep
RSV
Parainfluenza
Influenza
Investigations in pneumonia
CXR
Sputum and throat cultures
Blood gas
Lactate!
Management of pneumonai
Antibiotics - amoxicillin
O2
Define croup
An acute infection of the upper respiratory tract causing oedema in the larynx typically affecting young children
Causative organism in croup
Parainfluenza virus
(influenza, adenovirus, RSV)
Presentation of croup
Increased work of breathing
Barking seal like cough
Hoarse voice
Stridor
Low grade fever
Management of croup
Dexamethasone!!!
O2
Nebulised budesonide
Nebulised adrenaline
Intubation and ventilation
Define epiglottis
Inflammation and swelling of the epiglottis caused by infection
Causative organism in epiglottitis
Haemophili’s influenza type B
Presentation of epiglottitis
Sore throat and stridor
Drooling
Tripod position
High fever
Difficulty
Muffled voice
Scared and quiet child
Septic and unwell appearance
Investigations in epiglottitis
Do not examine!
Refer to ENT
Lateral xray of neck - thumb sign.
Management of epiglotitis
Refer to ENT!
Secure airway - ?intubate
IV abx
Teroids
Define Laryngomalacia
A condition that affects infants where the part of the larynx above the vocal cords is structured in a way that allows partial obstruction of the airway - leading to chronic stridor on inhalation.
Define whooping cough
Upper respiratory tract infection where child has classic coughing fits followed by loud whooping noise sucking air in.
Causative organism in whooping cough
Bordetella pertussis
Presentation of whooping cough
Mild coryzal
Low grade fever
Mild dry cough
Severe coughing fits - paroxysmal
Inspiratory whoop at ends of coughing fit.
May develop pneumothorax
Apnoeas
Investigations in whooping cough
Nasopharyngeal or nasal swab and PCR testing or bacterial culture
Management of whooping cough
Notifiable disease
Supportive care
Avoid contacts - prophylactic abx
Macrolides - clarithromycin
Define chronic lung disease of prematurity
Also known as bronchopulmonary dysplasia
Premature babies suffer respiratory distress.
Features of bronchopulmonary dysplasia
Low O2
Increased work of breathing
Poor feeding and weight gain
Crackles and wheezes
Increased infections
Prevention of chronic lung disease of prematurity
Steroids in premature labour
CPAP
Caffeine
Not over oxygenating
Management of chronic lung disease of prematurity
Low dose home oxygen
Monthly RSV monoclonal antibodies
Define cstic fibrosis
Autosomal recessive conditiong affecting mucus glands. Affects chloride channels
Key consequences of cystic fibrosis mutation
Thick pancreatic and biliary secretions - lack of digestive enzymes
Low volume thick airway secretions - reduce airway vlearance
Congenital bilateral absence of the vas deferens
Presentation of cystic fibrosis
Newborn bloodspot test - heel prick
Meconium ileus
Recurrent lower resp tract infection
Chronic cough
Thick sputum
Loose greast stools
Abdo pain
Parents report child tastes salts
Poor weight gain
Clinical signs of cystic fibrosis
Low weight or height
Nasal polyps
Finger clubbing
Crackles and wheezes
Abdo distension
Causes of clubbing in children
Hereditary
Cyanotic heart disease
Infective endocarditis
Cystic fibrosis
Tuberculossis
Inflammatory bowel disease
Liver cirrhosis
Investigations in cystic fibrosis
Newborn bvlood spot test
Sweat test - gold standard
Genetic testing -
Common infectious organisms in cystic fibrosis
Staphylococcus aureus
Pseudomonas aeruginosa
Haemophilus influenza
Klebsiella penumoniae
E. Coli
Burkhodeheria cepacia
Management of cystic fibrosis
Chest physio
Exercise
Hight calorie diet
Creon tablets
Prophylactic flucloxacillin
Treat infection
Bronchodilatiors
Nebulised DNase
Nebulised hypertonic saline
Pneumococcal influenza and varicella vaccines
Lung transplant
Liver transplant
Fertility treatment - soerm extraction
Genetic counsellingd
Define primary ciliary dyskinesia
Also knowns as kartagner’s syndrome
Autosomal recessive condition affecting the cilia of various cells in the body. Common in inbred populations
