Respiratory Flashcards
Differential diagnosis of stridor
Differential diagnosis of stridor: • Croup • Bacterial tracheitis • Epiglottitis • Foreign body aspiration • Subglottic stenosis (congenital or iatrogenic) • Laryngomalacia/trachiomalacia (collapse of airway cartilage on inspiration) • Vocal chord palsy
Causes of croup
Paraninfluenza virus, metapneumovirus, RSV, andn influenzae
Differential for croup
Epiglottitis, Bronchiolitis, Foreign body, bacterial tracheitis, Pertussis
Treatment of Croup:
Oral Prednisolone 1mg/kg or Dexamethason. If it doesn’t improve add nebulised adrenaline
Organism causing bacterial tracheitis:
Staph Aureus
Difference in presentation and management of Croup and bacterial Tracheitis:
Presentation: BT - the child has a high fever, toxic and has a rapidly progressive airways obstruction with copious thick airway secretions.
Management: Antibiotics, Intubation and ventilation if required
Cause of epiglottitis
H. influenzae
Clinical features of Epiglottitis:
High fever, toxic child, 4D’s: drooling, dysphagia, dysphonia and distress
Management of Epiglottitis:
Don’t distress the child and call ambulance.
Child should be inubated (possible tracheostomy), once airway is secure - BC and start on cefuroxime
Prophylactic management of epiglottitis?
- Other children in the house could be treated with prophylaxis Rifampicin.
Treatment of GAS pharyngitis and Tonsillitis?
Phenoxymethylpenicilin with panadol
Treatment of Peritonsillar abscess:
IV Benzylpenicillin and IV Metronidazole
Ipslateral ear pain, Dysphagia/odonophagia, Drooling, trismus and high fever
Peritonsillar Abscess
Sore throat, no coryzal symptoms, sudden onset, Abdominal pain/vomitting,
GAS pharyngitis
Dysphagia/odonophagia, Drooling, Neck rigidity and tenderness, high fever
Retropharyngeal abscess
What age group affected by retropharyngeal abscess
2-4 years
Age group affected by Epiglottitis
1-6yr unvaccinated
Age group affected by Croup?
6mo-3yr
Signs of increased work of breathing
Nasal flaring Paradoxical breathing Abdominal breathing Tachypnea Pursued lips Sternal recession Tracheal tug Head bobbing Grunting
What is subglottic stenosis
Narrowing of the upper trachea immediately below the glottis
Cause of Subglottic stenosis?
Often from trauma of premature infants who require intubation
When and how does subglottic stenosis present?
During times of infection - if severe can have an expiraory component with stridor and sternal recessions.
Generally Improve on their own
What is the most common cause of PERSISTENT stridor
laryngomalacia. Will last 2-3 years but should improve on it’s own
What is laryngomalacia?
Subglottic tissue appears as if they are too large and hence narrows the glottis aperture during inspiration
Cog wheel stridor, Worse when lying supine or crying, persistent occurring in a 2-3 year old since birth
Laryngomalacia
Cough, fever in an infant for about 2 weeks?
Bronchitis
What is the catarrhal (prodromal) phase of whooping cough?
Phase 1: 1 week of coryzal symptoms
What is the paroxysmal phase of whooping cough?
Phase 2: There is a paroxysmal cough for 3 to 6 wks with spasmodic coughing (sticato – not wet) causing vomiting, cyanosis, epistasis and subconjunctival haemorrhage. With a whoop to get some air
What is the covalescent phase of whooping cough?
Resolution of symptoms - may take months
Complications of whooping cough
Pneumonia, Febrile convulsions, encephalopath
Investigations for whooping cough
NPA swab, marked lymphocytosis on blood film and Serology (IgA Pertussis)
Management of whooping cough?
- Report
- Neonates - azithromycin oral daily for 5 days
- Children who cannot swallow tablets Clarithromycin liquid 7.5mg/kg/dose (max 500mg) oral BD 7/52
- Children who can swallow azithromycin (for children = 6months old); 10mg/kg (max 500mg) on day 1, then 5mg/kg (max 250mg) daily for 4 days
What is the infectious period of whooping cough?
Who gets prophylactic treatment of whooping cough?
Confirmed contact
AND first contact was within 14 days (or within 21 days for infant
Age group affected by Bronchiolitis?
1-9mo. rare after 1yr
Causes of Bronchiolitis?
RSV, Parainfluenzae, adenovirus, mycoplasma, metapneumovirus. Combination in 10-30%
Presentation of Bronchiolitis:
Coryzal symptoms first 2 days. Day 3 worst.
Increased WOB, Hyperinflation of the chest, Fine inspiratory crackles, Apnea and cyanosis, High-pitched wheeze - expiratory more than inspiratory
Management of bronchiolitis:
O2 (HFNP or LFNP), NG tube? Admission? supportive therapy? ventilation?
Monoclonal antibody to RSV?
A monoclonal antibody to RSV reduces the number of hospital admissions in high-risk preterms
Causes of childhood wheeze?
Transient early wheezing Atopic asthma (IgE mediated) Non-Atopic asthma (exercise and cold) Inhaled foreign body Cystic fibrosis Recurrent anaphylaxis in a child with food allergies Congenital abnormality of lung - CLD Bronchiolitis
