Respiratory Flashcards
How do you confirm otitis media?
Kid with a sore ear
Look in to see redness and bulging drum –> Spontaneous rupture
How do you treat otitis media?
It’s self limiting and generally viral so just analgesia
If it’s bilateral or <2yrs you could use oral amoxycillin
How would you investigate a case of tonsillitis?
1) Examine by looking in their mouth
2) Throat swab for viral vs bacterial
How do you treat tonsillitis?
If you confirm its bacterial you can give Penicillin
Otherwise nothing but analgesia
Do not give Amoxycillin! causes rash
kid presents with Coryza, stridor, hoarse voice and a “barking” seal-like cough, what’s the likely diagnosis?
Croup
These patients tend to be overall quite well
What causes Croup
Parainfluenza Type 1
How do oyu handle croup?
Oral Dexamethasone
What management should be enacted for any kid with a respiratory infection?
Assess their oxygenation, hydration and nutritional status then attend to these if necessary, Most kids won’t need anything more than this for Respiratory infections
Kid presents systemically very unwell with stridor and drooling, what do you think might be happening?
Epiglottitis
What cause epiglottitis?
H. Influenzae B
How would you manage epiglottitis?
Intubation & Abx
List atleast 3 bacteria and viruses known to cause LRTIs?
- Pneumococcus
- H Influenzae
- Morazella Catarrhalis
- Mycoplasma Pneumoniae
- Chlamydia Pneumoniae
- RSV
- Adenovirus
- Parainfluenzae 3
- Influenzae A & B
- Rhinovirus
What’s the most common LRTI in infants?
Bronchiolitis
Caused mostly by RSV or sometimes parainfluenzae 4 or HMPV
How would you expect bronchiolitis to present?
<12 months old
One off episode of:
- Nasal stuffiness (e.g. common cold)
- ~3day h/o progressive tachypnoea, feeding problems, crackles +/- wheeze
How would you investigate and treat an infant with bronchiolitis?
A NPA & O2 sats is all that’s needed
Focus on their oxygen, hydration & nutrition and most will recover on their own
(Remember it’s viral so it can’t be treated with Abx)
Mom brings in her son saying he’s been going through episodes all winter of a rattly cough & post-coughing vomit that’s mucousy. What does it sound like?
Bronchitis
Tend to see:
- Mostly well kid
- 6months to 4 yrs
- Relapsing remitting pattern
- Loose Rattyl Cough
- Post-tussive Vomit (“glut”)
- No wheeze/creps
What causes bronchitis?
Usually a viral infection e.g. RSV disturbs the mucocilliary escalator leading to a secondary bacterial infection with:
- Haemophilus Influenzae
- Pneumococcus
Bronchitis is generally managed with reassurance and waiting, when would we be more worries?
Red Flags include:
- <6months / 4yrs
- Static or dropping weight
- Disrupts Child’s Life
- SOB when not coughing
- Acute admission
- Co-morbidities e.g. neuro/gastro
Kid comes in with mum complaining of a 2 day history of Fever, SOB & Coughing, what do we call that?
A LRTI or Chest Infection
Characterized by 48hrs of fever, sob, cough +/- wheeze, reduced/bronchial breath sounds & creps
Don’t call it pneumoniae as it unnessarily scares parents
How do you investigate and treat a LRTI/chest infection?
Generally no need for inflammatory markers, CXR or medications, if its bad you can do FBC, CRP, CXR etc.
- Mild = no meds
- Worse? = Oral amoxycillin –> Oral Macrolide 2nd line –> IV if vomiting
What characterizes Pertussis?
Whooping cough:
- “coughing fits”
- vomiting
- Colour change
What is needed to diagnose Asthma?
Chronic
Episodes of wheeze, cough & SOB at rest
Variable/Reversible
Responds to asthma meds
It can help to look for a h/o or FH/o asthma & atopic conditions e.g. hayfever, eczema or food allergy
How do we test for asthma>
You don’t really
Spirometry, peak flow monitoring & allergy testing are often done but not reliable/definitive
Trial for 2 monhts with low dose ICS –> Gets better = asthma
What mnemonic can you use to assess how well the child’s asthma is controlled?
SANE:
- SABA /wk
- Absence from school/nursery
- Nocturnal symptoms /wk
- Exertional symptoms /wk
What’s first line for treating asthma?
SABA as required e.g. salbutamol
What’s second line for Asthma?
A low dose ICS or if <5yrs a LTRA (Montelukast)
When would you progress to 2nd line asthma meds?
IF using the B2 agonists >2days/wk
If symptomatic >3x/wk
Or if Waking >1night/wk
What’s third line for childhood asthma?
Inhaled LABA
After that you can adjust doses or experiment with theophylline or biologics e.g. omalizumab
What non-medical things actually help with asthma?
Stopping smoke exposure
Removing environmental triggers e.g. cat or dog
Diet, humidity, wt & hypoallergic duvets etc don’t help
What’s different about childhood to adult asthma treatment?
Kids have lower max ICS doses
Use LTRAs early in <5yrs
No LAMAs in kids
How do you deliver inhaled drugs in kids?
MDI Spacer
Dry powder inhaler, only start using it properly when they’re about 8
Summary of Asthma meds:
1) SABA as required
2) Low Dose ICS
3) Inhaled LABA
4) LTRA
5) Dose adjustments, theophylline & biologics
In <5yrs move LTRA up to step 2
Which respiratory infections would we use Abx for?
- Otitis media only if bilateral & <2yrs
- Tonsilitis if you’ve done a throat swab so you’re sure it’s bacterial (Penicillin, NOT Amoxycillin)
- Epiglottitis (along with intubation)
- Bad LRTI/chest infection (Amoxycillin –> Macrolide)
quick summary of bronchiolitis?
- Infants
- Viral (RSV)
- One off episode of nasal stuffiness, progressive tachypnoea, poor feedings, crackles over a few days
Supportive therapy, monitor O2 sats and do NPA
Quick summary of Bronchitis?
- 6months to 4yrs
- Bacterial secondary to viral (H influenzae or Pneumococcus)
- Well child
- Relapsing remitting pattern of loose rattly cough & post-tussive vomit
Reassure & don’t treat
Quick Summary of LRTI/chest infection?
- Commensal bacterial overgrowth secondary to viral infection
- 48hrs of fever, SOB & coughing
Oral amoxycillin only if it’s bad, macrolide as 2nd line and IV if vomiting
Quick Summary of Croup?
- 6 months to 6 years
- Coryza, stridor, Hoarse, “Barking” Cough
- Viral (Parainfluenzae 1)
Treat with Oral Dexamethasone
