Respiratory/Cardiology Flashcards
(44 cards)
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
