Respiratory Flashcards
What is croup and how does it occur?
Laryngotracheobronchitis:
- Upper respiratory tract infection caused by viral infection - normally parainfluenza, influenza and RSV
- Leads to swelling of the larynx, trachea and bronchi causing some degree of upper airway obstruction
Presentation of croup…
- Barking cough
- Stridor
- Hoarse voice
- Coryzal symptoms - nasal congestion
- Low grade fever
- Normally seen in 6mths- 6 yrs
Management of croup…
Mild -moderate:
- Dexamethasone (0.15mg/kg PO STAT) or Prednisolone (1-2mg/kg STAT) - can be sent home if good response
Severe:
- Nebulised adrenaline
- ITU admission if worsening
- Oxygen may be needed if SpO2 <92%
What causes epiglottitis?
Normally caused by haemophilus influenzae type B
How does epiglottitis present?
- Sudden onset with continuous stridor
- Drooling secretions
- No barking cough
- Toxic and feverish
- Swollen, cherry red epiglottis will be seen
Treatment of epiglottitis?
Cefotaxime
Key features of viral induced wheeze…
- Normally occur between 12 mths - 5 yrs
- Wheeze only during viral illness
- Rapid onset of wheeze
- Responsive to beta agonists e.g. salbutomol
Management of viral induced wheeze…
Moderate (able to talk, mild recessions, RR<40):
- Salbutomol inhaler - 6-10 puffs via spacer and mask
Severe (difficulty talking, use of neck muscles, RR >40):
- Salbutomol inhaler - 10 puffs via spacer, then 2 more doses of 10 if required
- May need secondary care if no improvement
Life threatening (low GCS, cyanosis, silent chest):
- Nebulised salbutomol
- Emergency care required
What is the commonest cause of bronchiolitis?
RSV infection
Can also be caused by adenovirus, rhinovirus, parainfluenza
Presentation of bronchiolitis…
- Normally seen in <1 year olds
- Coryzal symptoms seen first
- Sharp, non-productive cough
- Difficulty feeding due to breathlessness
Examination findings for bronchiolitis…
- Fine-end inspiratory crackles
- Expiratory wheeze
- Intercostal recessions
Management of bronchiolitis…
In the community:
- Saline nasal drops
- Nasal suctioning
- Baby sleeps propped up
- Feed little and often
Secondary care required if ; <50% normal food intake, RR>50, dehydrated, exhaustion
- Humidified oxygen
- NG feeding
Why do beta agonists not help in bronchiolits?
Beta receptors have not yet developed therefore beta agonists cannot work effectively.
Pathophysiology of asthma…
- Bronchial hyperactivity and smooth muscle hypertrophy
- Causes chronic inflammation of airways
- Widespread reversible bronchospasm
Risk factors for childhood asthma…
- Family history
- Low birth weight
- Bottle fed
- Atopy
- Prematurity
What are the symptoms of moderate asthma attack, and where are they managed?
- Able to talk in sentences
- Peak flow >50% of best/ predicted
- HR<140 and RR<40 in 2-5 y/o
- Normal skin colour
- No chest sounds/ slight wheeze
Management = admitted, or watchful waiting then go home
What are the symptoms of severe asthma attack, and where are they managed?
- Only speaks few words/ unable to feed
- Peak flow = 33-55% of best/predicted
- HR >140 and RR >40 in 2-5 y/o
- Pallor
- Wheeze is heard
Management= admitted to hospital
What are the symptoms of life-threatening asthma attack, and where are they managed?
- Unable to speak or cry
- Exhausted
- Drowsy/ confused
- Peak flow <33% of best/ predicted
- Cyanotic
- Silent chest
Management = escalation to ITU
Management of acute asthma attack…
O SHIT ME (not in that order!)
- High flow oxygen if sats <94% - aiming for 94-98%
- SABA back to back nebs - may add Ipratropium Bromide if poor response to SABA alone
- Nebulised magnesium sulphate can be added
- Oral prednisolone 40-50mg - continued for up to 3 days
- Consider escalation to PICU
- First line IV treatment= IV magnesium sulfate
- IV aminophylline
Follow up after acute asthma attack…
- Take detailed history to identify cause of asthma attack
- Review asthma medications and inhaler technique
- Create asthma action plan
- GP review within 2 working days
- Seen in clinic in 4 weeks
- Should not be discharged until PEFR >75%
Name some common inhalers and the drug included in them…
Salbutomol = blue inhaler - SABA Beclomethasone = brown inhaler - ICS Symbicort = red inhaler - ICS + SABA Seretide = purple inhaler - ICS +LABA Spiriva = green inhaler - LABA
Long term management of paediatric asthma…
- SABA as intermittent reliever therapy
- Very low dose ICS = regular preventer
- Initial add on = LABA or LTRA with ICS in combination inhaler e.g. seretide
- Increase ICS to low dose
- Referral to specialist care
What is cystic fibrosis ?
Autosomal recessive disease caused by mutations in CFTR gene.
This causes exocrine gland dysfunction - which has a variety of clinical manifestations.
Presentation of cystic fibrosis…
Exocrine gland dysfunction:
- Meconium ileus in neonates
- Lung disease similar to bronchiectasis, leading to reccurent pneumonia, wet cough (due to mucus)
- Biliary disease - neonatal jaundice, gallstones
- Pancreatic insufficiency - diabetes, steatorrhoea (due to malabsorption), pancreatitis
- Failure to thrive
