Respiratory/Cardiology Flashcards
prodrome URI hoarseness inspiratory stridor cough (barking, "seal-like") often starts at night and is worse at night
etiology: parainfluenza virus (sometimes RSV too)
6mo-3yo most common
Viral Croup
Viral Croup diagnostics and treatment
steeple sign on radiography
mild = no stridor at rest
–> supportive care, cool mist
moderate = stridor + mild retractions
–> corticosteroids (dexamethasone), nebulizer racemic epinephrine
severe = stridor, retractions and labored
–> airway support and admit
rapid onset fever, sore throat dysphagia, drooling, distress (3 D's) tripod/sniffing posture "hot potato" voice
etiology: H. influenza type B (bacterial)
Hib vaccine has greatly reduced incidence
Epiglottitis
Epiglottitis diagnostics and treatment
thumb sign on radiography
EMERGENCY –> can lead to life-threatening airway obstruction
DO NOT USE TONGUE BLADE
airway support - ET tube if possible
ceftriaxone
recurrent harsh, barking cough
stridor
floppy trachea during expiration due to inadequate supporting cartilage
aggravated by respiratory tract infections and agitation
Tracheomalacia
Tracheomalacia treatment
6mo-1yo cartilage becomes stronger and sxs usually resolve
if severe = CPAP
*some crania-facial abnormalities can lead to tracheomalacia
Foreign Body Aspiration
suspect if abrupt onset cough, choking, wheezing
potential stridor if caught in upper airways
12-24mo peak incidence
commonly food, paperclips, coins, balloons (most fatal)
*can potential go down right main bronchus because angle
CXR and BRONCOSCOPY (treatment)
“cough of 100 days”
prolonged bronchitis
complications: apnea, pneumonia, seizures and death
bacterial - B. pertussis
Pertussis (Whooping Cough)
Pertussis (Whooping Cough) phases
- catarrhal = URI sxs, fever (1-2wks)
- paroxysmal = persistent cough, inspiratory “whooping”, emesis (2-6wks)
- convalescent = cough gradually resolves (wks-mos)
*adults won’t always present with these 3 phases
Pertussis (Whooping Cough) diagnostics and treatment
nasopharyngeal swab/aspirate = gold standard
CBC = leukocytosis (bacterial)
CXR = normal or segmental atelectasis
treat with macrolides (erythro/azithro)
hospitalize if: respiratory distress, cyanosis/apnea, inability to feed or less than 4mo old
cough conjunctivitis nasal congestion fever apnea
*most common cause of lower respiratory tract infection in children less than 1yo
Respiratory Syncytial Virus (RSV)
Respiratory Syncytial Virus (RSV) diagnostics and treatment
complications: bronchiolitis, bronchospasm, acute respiratory failure
Dx with nasopharyngeal culture
hand washing
avoid contact with RSV-infected
prophylaxis with palivizumab = monthly injection during season in high risk patients less than 2yo
2-3 days URI sxs then: low grade fever cough expiratory wheezing respiratory distress = tachypnea, retractions, nasal flaring
etiology: RSV #1, rhinovirus
peaks 2-6mo old
Nov-Apr
Bronchiolitis
Bronchiolitis diagnostics and treatment
clinically based on sxs, age, time of year
RSV nasopharyngeal swab in the ERs
anticipatory guidance:
– 1-2 wks
– nasal secretions (suctioning helps)
– seek help if increased respiratory distress
hospitalization for supportive measures (i.e.. hydration and oxygenation)
*inhaled bronchodilators DO NOT improve overall outcomes
persistent, productive cough
50% of children with “failure to thrive” are diagnosed with this condition
avg age of survival is 30yo
*most common fatal autosomal recessive disease in US
abnormal trans-membrane Cl- transport
multi-system disease
Cystic Fibrosis
Cystic Fibrosis diagnostics and treatment
CXR = hyperinflation
*sweat chloride test >60 meq/L
abx
chest physiotherapy
mucolytics, steroids, bronchodilators
chronic cough with sputum
abnormal dilation of bronchi
PFT show obstructive pattern
*CF is #1 cause
walls of bronchi become damaged/weakened over time
Bronchiectasis
Bronchiectasis treatment
abx
pulmonary drainage
possible bronchodilators
fever, cough
myalgia, HA, malaise
pleuritic chest pain or abdominal pain
sxs may be subtle in infants: poor feeding, irritability, restlessness
*tachypnea tachycardia decreased O2 saturation cradles/rales, rhonchi grunting = imminent respiratory failure
consolidation of alveolar spaces –> infection of lung and parenchyma
*leading COD in children
Pneumonia
Pneumonia etiologies
fungal = newborn - 1mo
–> inclusion conjunctivitis if Chlamydia infection
viral = 1-12mo (RSV #1), 2-5yo (RSV, parainfluenza, influenza)
bacterial = 5-18yo (S. pneumoniae mostly, older = atypical bacteria)
Pneumonia diagnostics and treatment
radiography not needed
blood cultures if toxic
sputum if severe
treat empirically first
respiratory support
close f/u and admit
outpatient = amoxicillin (no abx if viral)
- -> 2/3 ceph or clindamycin as second options for infant/preschool
- -> azithromycin as second option for school age
inpatient = ampicillin/sulbactam
cefuroxime
ceftriaxone
Pneumonia hospitalization
Infants/Older children: apnea/grunting poor feeding SpO2 less than 92% infants = RR >70 breaths per minute older children = RR >50 breaths per minute
*comorbidities, f/u not possible or family unable to care for child
sxs begin within minutes of birth
respiratory distress = tachypnea, retractions, grunting, cyanosis, nasal flaring
deficiency of surfactant at birth = hypoxia as alveoli collapse
predisposing factors: preemie, fam hx, DM mother
acute diseases lasts 2-3 days but can progress to ventilatory failure
Infant Respiratory Distress Syndrome (RDS)
Infant Respiratory Distress Syndrome (RDS) diagnostics and treatment
arterial blood gas = hypoxemia
CXR = diffuse bilateral atelectasis
–> *ground glass appearance
O2 with CPAP
exogenous surfactant (given via ET tube)
IV fluids
prevention with antenatal glucocorticoid for mother
- -> dexamethasone or betamethasone
- -> hastens lung maturity in those expected to deliver in less than 32-34 weeks
cough (intermittent or chronic)
wheezing
dyspnea
chest tightness
RSV is a risk factor
allergic triad
chronic airway inflammation, hyper-responsiveness and reversible obstruction
Asthma
Asthma diagnostics and treatment
spirometry (also used to monitor disease)
–> measures lung volumes and flow rates in children >5yo via trained hospital staff
FEV1/FVC ratio decreases (obstructive)
stepwise approach to treatment:
short-acting bronchodilators (SABA) PRN (aka rescue inhaler)
inhaled corticosteroids (preventive and prophylactic)
LABA (with inhaled corticosteroids)
leukotriene antagonists
oral steroids
choking sensation/throat tightness
inspiratory stridor
cough
triggered by exercise, irritants, GERD or rhino sinusitis
inappropriate vocal cord motion = partial airway obstruction
Vocal Cord Dysfunction
Vocal Cord Dysfunction treatment
*often misdiagnosed as asthma
reassurance
*speech therapy
breathing maneuvers
avoid triggers
habitual snoring, gasping or apnea
2-3% children
risk: obesity and adenotonsillar hypertrophy
Dx: sleep study
Tx: adenoidectomy with possible tonsillectomy or CPAP
Obstructive Sleep Apnea
5 T’s of Cyanotic CHD
Tetralogy of Fallot Truncus Arteriosus Transposition Tricuspid atresia Total anomalous pulmonary venous return (TAPVR)
most common of all congenital heart defects
most common in Down Syndrome patients
large: failure to thrive/poor growth tachypnea hepatomegaly GERD
VSD
VSD Treatment
diuretics
ACE inhibitors +/- digoxin (lowers LVP)
most common type is secundum
usually asymptomatic because not much extra blood flow
ASD
ASD treatment
elective closure 2-5yo surgical or transcatheter
*never leave open in young girl approaching puberty
Atrio-ventricular septal defect (AVSD)
most common prenatal dx of CHD complete = large VSD and ASD CHF pulmonary HTN *repair in infancy
continuous “machinery” murmur can be heard front and back
enlarged RA, RV, LV
increased pulse pressure
Patent Ductus Arterioles (PDA)
PDA treatment
indomethacin may help closure
*many preemies have immature lungs which can make PDA dx difficult
Cyanotic CHD signs
check both UE and LE saturations arterial pulses (absent, delayed, bounding) *anemic baby may not look cyanotic because they don't have enough Hb to show it
need more than 5g/dL deoxygenated Hb to look cyanotic
Tetralogy of Fallot
RV output tract obstruction (cause of TET spells)
RV hypertrophy
VSD
overriding aorta
*fix by 3-6mo or sooner if blue
failure to separate aorta and pulmonary artery causing a large VSD
requires operation in first 2 weeks of life
Truncus Arteriosus
prostaglandins (PGE) started to keep ductus open
*BLUE BABY think PGE
aorta comes off RV and pulmonary artery comes off LV
Transposition
TAPVR
veins migrate from lungs to meet heart and form back of LA, but if lost, they form a CONFLUENCE
supra cardiac = repair in first 6mo of life
infra cardiac = usually obstructed –> EMERGENT
–> very sick with wet lungs, cyanosis and pulmonary HTN
proximal HTN
presents as extremis (near point of death)
irritability, tachypnea, poor feeding, CHF
decreased of absent femoral pulses
older children and teens may present with unexplained HTN
associated with Turner’s syndrome
when ductus is closed, muscle can also impinge on aorta causing LV failure
Coarctation of Aorta
Coarctation of Aorta diagnostics
CXR = rib notching (takes several years to develop)
*CT angiogram or MRA becoming GOLD STD
just need ECHO in infants for surgery
