Respiratory #2 Flashcards
What is the pathophysiology of respiratory distress syndrome?
Surfactant deficiency- phospholipids & proteins excreted by type 2 pneumocytes
Leads to alveolar collapse during expiration
Increased Surface tension & RR
Hypoxia & exhaustion
Compounded by poor muscle bulk & elastic ribcage in prem’s
When is respiratory distress syndrome usually seen?
50% at 32weeks
>90% <28weeks
What are the RFs for respiratory distress syndrome?
Prematurity! LSCS Hypothermia Acidosis Meconium aspiration Maternal DM FHx Congenital pneumonia
What are the signs & symptoms of respiratory distress syndrome?
Cyanosis: Within 4hr of birth Inc RR Chest indrawing Grunting within 4h Untreated: Worsens 48-72hrs Resolves: 5-7days
How is respiratory distress syndrome investigated?
CXR: Bilateral, diffuse ground glass-atelectasis
ABG
Sats
ECHO
How is respiratory distress syndrome managed?
Delivery room care & resus
Warm IV 10% Dextrose
Oxygen, nasal CPAP, Ventilation
Replace surfactant: Curosurf bolus down ETT, second dose 8-12h later
Abx: Penicillin & Gentamicin until pneumonia excluded
Nutrition
How is respiratory distress syndrome prevented?
Betamethasone/Dexamethasone 2doses 12hourly 1-7days before delivery
Max benefit 24hrs
Lasts 7days
Prevent hypothermia & acidosis (inhibits surfactant production)
What is a breath holding attack?
Infants and toddlers (6-18m)
Stimuli causes child to become anoxic
Due to vagal stimulation
What are the causes of breath holding attacks?
Noxious stimuli: Pain, shock, fear
What are the signs & symptoms of breath holding attacks?
Short cry followed by: Sudden Pale Limp Loss of consciousness Tonic-clonic jerking Eyes roll back Call for help if >5mins Blue breathing: Cry builds up until the child collapses at the end of expiration
How are breath holding attacks managed?
No investigations or treatment required
Most grow out of it
Reassure parents and child
Place in a safe place after trigger e.g on a mattress
What are the causes of infectious mononucleosis?
90% EBV
Cytomegalovirus
What are the signs & symptoms of infectious mononucleosis?
Symptoms last 2-3weeks may last for 3months Prodrome: Headache, chills, fever Jaundice Splenomegaly Lethargy/malaise Tonsillitis Tender lymphadenopathy Pharyngitis Erythematous macular rash
How is infectious mononucleosis investigated?
Monospot test: ImmunoC adults & >12yrs
Bloods: LFTs, thrombocytopenia
Lymphocytosis >10% atypical lymphocytes on film
Who does infectious mononucleosis usually affect?
15-24years
How is infectious mononucleosis treated?
Symptomatic-Analgesia (Paracetamol/Ibuprofen)
Avoid contact sports
No OH-
Avoid Amoxicillin- Maculopapular RASH
What are the complications of infectious mononucleosis?
Hepatitis Splenic rupture Meningitis Encephalitis Guillain-Barre
What objects are most commonly inhaled?
Grapes Nuts Sweets Coins Marbles Toys
What age is foreign body aspiration most common?
1-2years
What are the signs & symptoms of foreign body aspiration?
Larynx: Hoarseness, Cough, Dyspnoea, Stridor, Haemoptysis, Wheezing, Cyanosis, Apnoea
Trachea: Pneumonia
Oesophagus: Drooling, Vomiting, Dysphagia, Dyspnoea, Resp failure
How is inhaled foreign body diagnosed?
Monophonic wheeze
Absent sounds on one side
How is an inhaled foreign body investigated?
CXR
ABG
How is an inhaled foreign body treated?
ABCDE Encourage coughing If visible remove foreign body 5 Back blows 5 Abdominal thrusts Unconscious: Oxygen & rigid bronchoscopy
What are the signs & symptoms of TB?
Primary infection: Asymptomatic
Re-activation: Cough, haemoptysis, fever, night sweats, dyspnoea, anorexia
How is TB investigated?
Mantoux: 2-4days
Heaf: 5-7days
How is TB treated?
Anti-TB meds for 6months (4drugs for 2m then 2drugs for 4m)
Rifampicin, Isoniazid, Ethambutol, Pyrazinamide
