Respiratory Flashcards
Bronchiolitis-Ix
Obs-Resp rate, heart rate Pulse oximetry Blood gas if severe disease CXR if like wasting money PCR nasal secretions to identify virus
Bronchiolitis-Tx
Supportive: humidified O2 via nasal cannulae, fluids, ventilation (CPAP), hypertonic 3% saline nebs
Infection control measures (wash hands)
Preventative: palivizumab in high risk prems
Laryngotracheobronchitis
Aka croup
Mucosal inflamm and increased secretions affecting airway
Edema of subglottic airway can cause narrowing trachea
Peak incidence in 2nd year life
Parainfluenza virus
Croup-sxs
Preceding fever and coryza
Barking cough, harsh stridor, hoarseness
Worse at night
Croup-tx
Most resolve spontaneously.
Inhalation warm moist air, observation at home
Steroids: oral dex/pred, neb budesonide
Admit if severe,
CF-cause, epidemiology, sxs
1/2500
Carrier rate 1/25
Defective CFTR gene on chromo 7. Delta F508 most comm mutation
Impaired cilia fn (thus pneumonia, infertility), viscous meconium –meconium ileus, pancreatic duct blocked by thick secretions (thus enzyme deficiency and malabsorption), excessive NaCl in sweat
FTT
95% die of resp failure
Screening via heel prick test
CF-tx
Specialist management
Prophylactic abx (fluclox), plus rescue Abx, daily nebulized anti-pseudomonal Abx
Nebulized DNAse and hypertonic saline to decrease viscosity
Deep breathing exercises for older children
Twice daily physio to clear secretions.
Parents should be taught to perform airway clearance
B/L lung transplantation only tx for end-stage CF
pancreatic replacement therapy with all meals
High calorie diet essential
Fat soluble vitamin supplementation
Ursodeoxycholic acid
Oral gastrografin if intestinal obstruction
Laryngomalacia
Congenital cause upper airway obstruction
Larynx soft and floppy and collapses during breathing
Inspiratory stridor in otherwise well child in first few weeks life. Exacerbated by crying, feeding, lying supine, intercurrent chest infection
20% have another airway abnormality
Dx: flexi laryngoscopy
Resolves after 2 years
Monitor O2 sats
Surgery if severe (FTT, cor pulmonale, OSA)
Ddx infant with tachypnea or wheeze (common)
Infectious: Bronchiolitis (1-9months), Pneumonia, Croup, Epiglottitis Non-atopic wheezing: post viral LRTI, smoking parents Atopic asthma Cardiac failure Inhaled foreign body Trauma Retropharyngeal abscess Anaphylaxis
Ddx-child with stridor
Croup Epiglottitis Bacterial tracheitis Inhaled foreign body Largyngomalacia or congenital airway abnormality
Asthma triad (pathology)
Bronchial inflammation (Edema, XS mucus, cell infiltration) Bronchial hyperresponsiveness Airway narrowing (reversible)
Asthma-RFs
Genetics
Atopy (IgE-associated)
Environmental triggers: URTI, allergens, smoking, cold air, exercise, anxiety
Asthma-signs and sxs
Wheeze-polyphonic or multipitched on more than one occasion
Cough, breathlessness, chest tightness
Oft worse at night/early morning
Triggered (exercise, pets, dust, cold air, emotions, laughter)
With long standing: hyperinflation, generalised polyphonic expiratory wheeze, Harrison sulci
May also have eczema, allergic rhinitis (examine skin, nasal mucosa)
Asthma-dx
Skin-prick testing Trial salbutamol Peak flow diary Spirometry CXR to rule out other conditions
Bronchiolitis
- Cause
- Sxs
Most common serious resp infection of infancy
Winter months
RSV=80%
Coryza, cough, increasing breathlessness, feeding difficulty
Tachypnea, subcostal/intercostal recession, chest hyperinflation, fine end inspiratory crackles, high pitched wheeze
