Respiratory Flashcards
What are the signs of increased respiratory effort in children?
Childs position and use of accessory muscles Recession - IC and SC Nasal Flaring and Grunting Head bobbing Increased RR
Describe some of the signs of respiratory inadequacy in children
Increased HR
Change in skin colour
Decreased mental state
Describe normal respiratory rates in children of different ages.
Infant 30-40
1-5 years - 25-30
5-12 years - 20-25
>12 years - 15-20
Describe some of the core clinical features of cystic fibrosis
Persistant, loose cough, productive of purulent sputum with chronic chest infections
Failure to thrive - due to pancreatic ducts being blocked leading to pancreatic enzyme deficiency and malabsorption
How do the majority children with CF present in this country?
Majority are picked up as newborns from the heel-prick Guthrie test screen
Describe how newborns with CF may present with meconium ileus.
10-20% present with meconium ileus - causing intestinal obstruction - vomiting, abdo distension and failure to pass meconium within first few days of life. Most require surgery.
Describe the two patterns of wheeze seen in young children.
TRANSIENT - episodic wheeze associated with common cold, usually resolves by age 5
PERSISTANT AND RECURRENT - Frequent wheeze, triggered by many stimuli, lasts beyond pre-school years. If evidence of allergy = atopic asthma.
What are the core features of Asthma?
Wheeze, cough, beathlessness, tight chest.
Diurnal Variation (worse at night and early morning), e.g. nocturnal cough
Symptoms have triggers e.g. dogs, cigarrette smoke, pollen, dust
Interval symptoms - symptoms between acute exacerbations
Personal or family Hx of Atopy
Positive response to asthma therapy (reversible)
What clinical signs would indicate a child was in a severe acute asthma attack?
SpO2
What signs indicate a child is becoming exhausted - LIFE THREATENING?
Hypotension Confusion/Coma Silent Chest Cyanosis Decreased Respiratory Effort
How might a child with a pneumonia present?
Fever & Difficulty Breathing
+/- cough, lethargy, poor feeding
Localised chest, neck or abdo pain is a sign of pleural irritation and suggests bacterial infection
Usually preceded by an URTI
What are the common organisms causing pneumonia in the different age groups?
Newborn - organisms from mums genital tract, particularly GBS
Infants and Pre-School - viruses e.g. RSV Bacterial e.g. Strep Pneumoniae and Hib
>5 yrs - Strep pneumoniae, mycoplasma pneumoniae
What might be the clinical signs on examination in a child with pneumonia?
Increased RR, increased rep effort. Fever. Decreased O2 sats. May be end inspiratory crackles over affected area - however classic signs of consolidation are often absent in young children
What is Croup? And what is another name for it?
Viral URTI
Layngotracheobronchitis
What is the peak incidence of croup?
Can occur from 6 months to 6 years of age, but peak incidence is in the second year of life
What pathogen causes Croup?
Viral - usually parainfluenza virus
What are the core clinical features of Croup?
Barking cough, harsh stridor, hoarse voice.
Usually preceded by fever and coryzal symptoms
Describe the pathophysiology of Croup?
Symptoms are caused by mucosal inflammation and increased secretions affecting the airway.
Can get oedema of the sub-glottic area which is potentially dangerous as it may result in critical narrowing of the trachea.
Briefly outline the management of Croup
Mild - managed at home
Moderate - Severe - inpatient, inhaled or oral steroids, nebulised adrenaline, very few need intubation due to inhaled steroid use.
What is Bronchiolitis?
It is a viral LRTI
What age is the peak incidence of Bronchiolitis?
90% are aged 1-9 months
rarely affects infants > 1 year
What is the commonest viral pathogen causing Bronchiolitis? What other viruses can be responsible?
RSV in 80% of cases.
Others include- human metapneumovirus, parainfluenza, rhinovirus, adenovirus, influenza
What are the clinical features of bronchiolitis?
Coryzal Symptoms followed by dry cough and increasing breathlessness
Feeding difficulty due to dyspnoea
Recurrent apnoea is a serious complication
What would you hear on the chest of an infant with bronchiolitis?
Widespread fine inspiratory crepitations
What is the management of bronchiolitis?
SUPPORTIVE
Have a low threshold for admitting infants, for supportive oxygen, feeding and fluids.
Infection control methods are vital as it is highly infectious.
What is the prognosis of Bronchiolitis?
Most infants recover from the acute infection in 2 week
As many as half will have recurrent episodes of cough and wheeze
Rarely usually following adenovirus infection the illness may result in permanent damage to the airways - bronchiolitis obliterans.
What can be given to high risk infants to prevent them from developing bronchiolitis?
Monthly IM injection of monoclonal antibody palivizumab.
What is the biggest cause of anaphylaxis in children?
Food allergy (85%)
Describe some of the presenting features of anaphylaxis
Itching, Sweating D&V, erythema, urticaria, oedema of larynx, lids, tongue, lips
Leading to wheeze, laryngeal obstruction, cyanosis
Leading to tachycardia and hypotension
What type of hypersensitivity reaction is anaphylaxis?
Type 1 (IgE mediated) IgE binds to mast cells causing systemic release of histamine
What three drugs are given to treat anaphylaxis?
ADRENALINE
+ antihistamines and steroids
What symptoms might a child show if they were in heart failure?
BABIES Breathlessness - particularly on feeding(does baby change colour during feeds) Poor feeding,weight faltering CHILDREN Breathlessnes on exertion - decreased activity levels or lying down Cold peripheries Cyanosis of facial oedema Recurrent chest infections
How might we classify the causes of heart failure in children?
CONGENITAL
i.e. something structurally wrong with the heart, presents before 6 months of age
ACQUIRED
Can be from any acquired cause of heart dysfunction or structural abnormality, can present at any age
What investigations are done in a baby who has suspected bronchiolitis?
Nasopharyngeal Aspirate for Virology
CXR not routinely indicated
Measure O2 sats, can do blood gas if severe
