Respiratory Flashcards
What is croup
laryngotracheobronchitis
inflammation of the upper airway usually due to parainfluenza viral infection
age group affected by croup
6mth - 3 yr
symptoms and signs of croup
barking cough stridor dyspnoea fever cyanosis fatigue hoarse voice usually following having a cold
red flags / severe signs of croup
cyanosis / grey / pale drooling altered mental state absent breath sounds / quieter than before fatigue resp distress
how can croup be classified
mild
moderate
severe
impending resp failure
management of croup
paracetamol, rehydrate
mild - PO DXM and rest at home + SAFETY NET
mod-severe - admit, and give supplementary O2 and steroids
PO DXM / neb budesonide / IM DXM
what is epiglottitis and what is the usual cause
inflammation and swelling of the epiglottis
HiB bacterial infection
other causes include: strep penumoniae, viral, trauma, smoking
age group affected by epiglottitis
2-6 yr
symptoms and signs of epiglottitis
sore throat odynophagia + dysphagia stridor and breathing difficulties fever irritability hoarse voice decreased oral intake classic 'tripod' positioning drooling cherry red epiglottis
RF for epiglottitis
non HiB vaccination
immunocompromised
management of epiglottitis
admit
ABCDE
secure the airway - O2 mask, intubation, tracheostomy
FBC, CRP, throat swab and culture, Xray/CT
IV antibiotics - ceftriaxone (chloramphenicol)
in paediatrics what must be done before administering chloramphenicol
check plasma levels
what is bronchiolitis
inflammation of the bronchioles
causes of bronchiolitis
respiratory syncytial virus RSV - most common
rhinovirus
parainfluenza virus
RF for bronchiolitis
<6 wk premature immunocompromised other chronic conditions - neuro, cardiac, resp small for age
bronchiolitis is the most common infection in neonates and is usually self limiting, true or false
true
bronchiolitis is more common in children >2yo, true or false
false, it is more common in <2yo
asthma is more likely if >2yo
symptoms and signs of bronchiolitis
tachypnoea fever increased work of breathing: nasal flaring, intercostal recession, tracheal tug, abdominal breathing wheeze crepitations
red flags for bronchiolitis
apnoea or severe tachypnoea difficulty feeding cyanosis / grey grunting SaO2 < 92%
investigations are required to make a diagnosis of bronchiolitis, true or false
false, it is a clinical diagnosis
management of bronchiolitis
main principles: oxygenation and hydration as it is self limiting
mild - self limiting at home
mod - severe - admit, fluids, O2 support
impending resp failure - CPAP, NG feeding
antibiotics should be given in bronchiolitis, true or false
false!
asthma triad
airway inflammation
airway hyper responsiveness
reversible airway obstruction
pathology of asthma
bronchocontstriction
chronic airway inflammation
airway remodelling
BM thickening
submucosal collagen deposition
smooth muscle hypertrophy
RF / triggers for asthma
FH
atopy - eczema, hayfever
exercise
nasal polyps
symptoms and signs of asthma
wheeze episodic symptoms diurnal variation - worse at night/early morning dry cough failure to thrive
asthma has a dry/productive cough?
DRY non-productive cough
management of asthma
- SABA - salbutamol
- SABA + very low dose ICS or LTRA if <5yo
- SABA + ICS + LABA/LTRA or LTRA if <5yo
- SABA + increase ICS dose + LABA/LTRA (remove if unhelpful)
what are the PEFR ranges for severe and life threatening asthma
severe - 33-50%
life threatening <33%
signs of life threatening asthma
PEFR <33% apneoa silent chest exhaustion hypotension confusion cyanosis
management of acute life threatening asthma
high flow O2 if SaO2<94% with target 94-98% SABA add ipratroium bromide to SABA consider adding MgSO4 PO steroids - prednisolone CALL FOR HELP!
what are pMDI
pressurised metered inhalers
examples of pMDI
salbutamol
clenil modulite = beclometasone
seretide = fluticasone + salmeterol
pMDI can be used with spacers, true or false
true
technique for using pMDI
long slow deep breaths in and out of spacer
10 for younger children and 5 for older children
examples of spacers
volumatic, aerochamber
yellow = masked
blue = unmasked
who would use a masked spacer
preschool children
what are breath actuated inhalers
triggered by the patient
can breath actuated inhalers be used with a spacer
no
more convenient at school
what is DPI
dry powdered inhalers
examples of DPI and ages they can be used
turbohaler >=8yo
accuhaler >=12yo
ellipta
DPI are pressurised devices, true or false
false, therefore you need to breathe hard and fast
what is symbicort a mixture of
budesonide and formoterol
what is seretide a mixture of
fluticasone and salmeterol
what is clenil modulite
beclometasone
brown inhaler
what is the blue inhaler
salbutamol
SABA
inheritance pattern of CF
autosomal recessive
what test is done for CF in the heel prick test
immune reactive trypsinogen IRT
seretide inhaler is twice as potent as clenil, true or false
TRUE!
which steroid is used as treatment in croup, prednisolone or dexamethasone
dexamethasone
what are the 3 D’s for epiglottitis
drooling distress dysphagia
xray feature of croup
steeple sign
xray feature of epiglottitis
thumb print sign
