Respiratory

Question 1

What are the typical symptoms of croup?

Answer 1

Barking cough, hoarse voice, stridor

Question 2

What age ranges are affected by croup?

Answer 2

Typically 6mo-3yrs, but can occur (less commonly) up to early teenage years

Question 3

What is croup?

Answer 3

Laryngotracheobronchitis - inflammation of the larynx, trachea and bronchi

Question 4

What is the treatment for mild/moderate croup?

Answer 4

Oral prednisolone 1mg/kg up to a single max dose of 50mg, provided no prednisolone within 24hrs.

Question 5

What is the treatment for severe/life threatening croup?

Answer 5

Oxygen therapy

Nebulised adrenaline
* < 6 months nebulised adrenaline 2.5 mg, make to 5 mL with saline. Repeat prn
* ≥ 6 months nebulised adrenaline 5 mg/5 mL. Repeat prn

Oral prednisolone (if tolerated, and only after adrenaline neb)
* 1 mg/kg to max 50 mg

Transport and notify receiving facility

Question 6

Asthma may be classified as severe if patients exhibit ANY of… (3 answers)

Answer 6

• Speaking words only
• Visibly breathless / increased WOB
• SpO2 90-94%

Question 7

Asthma may be classified as life-threatening if patients exhibit ANY of… (5 answers)

Answer 7

• Drowsy / collapsed
• Exhausted
• Cyanotic
• Poor respiratory effort
• SpO2 < 90%

Question 8

Is wheeze a good predictor of severe asthma? Why / why not?

Answer 8

Not necessarily; may have poor / low volume airflow which is insufficient to generate a wheeze

Question 9

What is the treatment for a pediatric < 6yrs with severe asthma (5 points)?

Answer 9

1. High flow O2
2. Request clinical support
3. Neb: salbutamol 7.5mg with ipratropium 250microg
4. If tolerated - oral prednisolone 1mg/kg if no doses within 24hrs
5. Treat as life threatening if no improvement

Question 10

What is the treatment for a pediatric < 6yrs with life-threatening asthma (5 points)?

Answer 10

1. High flow O2
2. Early clinical support
3. Continuous nebulised salbutamol with 250microg ipratropium every 20min (max 3 doses); use IPPV if required with small tidal volumes
4. Consider IM adrenaline 10microg/kg
5. Consider saline (consult if > 20ml/kg required)

Question 11

What is the treatment for a pediatric < 6yrs with moderate asthma (5 points)?

Answer 11

1. High flow O2
2. MDI with spacer (preferred); salbutamol 6 puffs, ipratropium 4 puffs, or
3. Neb: salbutamol 2.5mg and ipratropium 250microg
4. If tolerated - oral prednisolone 1mg/kg if no dose within 24hrs
5. Escalate to severe asthma if no improvement

Question 12

What is the first line therapy for exacerbation of COPD?

Answer 12

• Use current management plan where appropriate
• Nasal O2 - titrate SpO2 88-92%
• Salbutamol and Ipratropium MDI, repeat both every 20min or earlier if no improvement.