Respiratory Flashcards
Causes of acute cough
URTI / Laryngitis / Broncholitis , pneumonia / asthma / foreign body
Causes of chronic cough
asthma / allergic rhinitis / infection (TB) / uncommon (foreign body) / rare (CF, lung collapse)
Stridor - why in kids more than adults / common causes
Airways are narrower for kids
- croup / acute epiglottitis / foreign body / other obstructive lesion (tumor/abscress/glandular fever)
Croup - C / CF / T
C - 95% viral
CF - gradual onset, hoarse barking cough, stridor at rest +/- cyanosis
T - normally self-limiting / if severe admit to ICU
give abx’s + humidified O2 + neb adreniline + dexamethasone - cxray will show steeple trachea sign
Acute epiglotitis - why is it rarer than croup? / I / management
because of Hib vaccine / lateral neck xray (enlarged epiglottis)-clinical diagnosis / DO NOT DISTRESS child and dont examine throat! if confirmed a.epiglot then intubate to prevent throat closure. Bloods / abx’s +/- hydrocortisone
acute epiglot markers severity
cyanosis / restlessness / HR + RR increase / tiredness / sternal retraction
acute bronchiolitis - timeline + CF (signs which prompt admission) / C / I / T
timeline - day 1-3 = pre symptoms (runny nose) / day 4-7 builds to peak / 8-14 recession
CF - running nose, cough, LOW fever, tachyopnea, wheeze, feeding disruption
admit - poor feeding, apnoea, pt is exhausted, RR>50, rib recession
C - RSV (other parainfluenza/mycoplasma)
I - cxray (hyper inflation), abg’s , spO2, FBC
T - O2 (until sats >90%) + NG feeding + neb salbutamol
Pneumonia in kids - CF / I / T
CF - febrile, malaise, poor feeding, GRUNTING, cyanosis
I - cxray (consolidation/cavitation (TB) , bloods (FBC + cultures)
T - O2 (if acutely ill) + abx’s
(if under 2 years old give erythromycin +/- co-amox or amox)
azithromycin to take home
TB - RF/ CF / I / T
RF - suspect if overseas contacts / HIV pos / odd cxray
CF - anorexia, LOW grade fever, malaise, failure to thrive
I - culture + ziehl-nielson stain (x3) / cxray (caviations and consolidation)
T - RIP regime (stopping pyrazinimaide after 2 months)
Whooping cough (pertussis) - most common age / CF/ I/ T / comp
com age = 3
CF - apneoa, coughing to vomit +/- cyanosis (these epsides are worst at night / after feeding)
whooping sound when inspiring
differs from other LRTI as NO FEVER and NO WHEEZE
I - PCR, blood film+FBC (absolute lymphocytosis is common)
T - admit if under 6 months +/- erythromycin +/- vaccine
comp - prolonged illness (100 day cough) conjunctival + retinal haemorhages , apnoea
Asthma - RF / triggers/ CF / I /T
RF - low birth weight, fam hx, bottlefed, atopy hx, male
triggers - dust, pollen, feathers, fur, exercise, viruses
CF - wheeze, cough, SOB, noc cough,
I - peak flow
T - (BTS guidelines)
high prob = start trial of treatment
mod prob = peak flow before and after SABA
low prob = further tests
gradual system:
SABA +/- preventor steroid inhaler
check tehcnique + if >5 years old add LABA (salmeterol)
if not successful stop LABA, increase steroid dose and add leukotriene receptor blocker
If no success and SEVERE = add oral pred + refer to specialist
patho of asthma
reversible airway inflammation due to bronchial wall hyper-responsiveness
leads to mucus secreting cell hypertrophy so increased secreting and smooth musc hyperplasia
severe and life thrreatening asthma
SEVERE:
HR and RR up, cant finish sentences,
LIFE THREAT:
silent chest, BP down, cyanosis, GCS down, confusion
Devices used in asthma
Dry powder / metered dose (aerosol puffer)
Spacer - used with MDI + a mask if child
using a spacer tech
prime inhaler by shaking, attach, hake the spray, breath in deeply and slowly then hold breath for 10, rinse mouth
