Respiratory Conditions

Question 1

Croup

Answer 1

Viral infection and inflammation of the URT (aka laryngotracheobronchitis)
- Age: 6months -6years.
- Acute onset and duration 2-3days
S/S - barking cough, harsh cry, inspiratory wheeze, increased WOB, *fever.

Question 2

Croup - treatment

Answer 2

1. Mild - nil, supportive therapies.
2. Moderate - corticosteroids - e.g. dexamethasone, prednisolone.
3. Severe - corticosteroids and nebulised adrenaline.

Question 3

Croup - severity

Answer 3

1. Mild - normal RR, normal behaviour, stridor on activity or distress, minimal UOAM.
2. Moderate - increased RR, intermittent agitation, intermittent stridor at rest, moderate chest wall retraction.
3. Severe - increased or decreased RR, agitation/drowsiness, persistent stridor at rest, marked chest wall retraction and UOAM.

Question 4

Bronchiolitis

Answer 4

Viral infection and inflammation of LRT and lungs with mucous build-up.
- Age: infants < 6months (up to 12months)
- Progressive onset, peak 2-3 days and duration 7-10 days
S/S - increased RR, noisy breathing, wheezing, increased WOB, UOAM, interrupted eating/drinking, irritability, fever.

Question 5

Bronchiolitis - treatment

Answer 5

1. Mild - nil, supportive therapy (rest, small dose feeding, saline nasal sprays)
2. Moderate - 1-2hr obs, O2T via NP (with humidifier), NG hydration (if < 50% intake in 12hrs)
3. Severe - 1hr obs with CCM, O2T via HFNP or CPAP, NG hydration.

Question 6

Pertussis

Answer 6

Bacterial infection and inflammation of respiratory tract and lungs caused by bortadella pertussis (aka whooping cough)
- Age: < 6months (to adulthood)
- Progressive onset, duration 1-6 weeks (up to 10 weeks)
S/S - initial cold/flu symptoms, protracted coughing spells, high-pitched ‘whoop’ on inspiration, vomiting due to cough, apnoea (infants).
Management- supportive therapy (rest and small dose feeding), isolation for 3 weeks (if no ABs) or first 5 days of ABs, immunisation of close contacts, hospitalisation if < 6 months, ABs (complicated/prophylaxis).

Question 7

Pneumonia

Answer 7

Viral or bacterial infection and inflammation of one or both lungs.
- Bacterial - acute onset, duration 1-2 weeks, severe symptoms.
- Viral - progressive onset, duration 4+ weeks, mild symptoms.
S/S - cold/flu symptoms, cough, chest pain, fatigue, fever, wheeze/crackles, consolidation/infiltrates on CXR, dullness on percussion.
Management
- Viral - nil, supportive therapy.
- Bacterial - ABs (amoxicillin PO or ceftriaxone/flucloxacillin IV), NG hydration, O2T.

Question 8

Otitis Media

Answer 8

Infection and inflammation of middle ear with/out effusion.
- Age: 6-18months, pre-school age.
S/S - otalgia, fever, anorexia, vomiting, lethargy, red-bulging-opaque TM, TM perforation.
Management - CONSIDER OTHER DIAGNOSES IN FEBRILE CHILD (ESP. < 6MONTHS).
Mild - analgesia (incl. topical 2% lignocaine), nil ABs for 48hrs.
Complicated - analgesia, ABs (amoxycillin).

Question 9

Asthma

Answer 9

Chronic inflammatory disease of airways involving hypersensitivity, reversible airway obstruction and bronchospasm.

Question 10

Asthma - severity

Answer 10

1. Mild - alert, minimal WOB, normal speech.
2. Moderate - alert, moderate i WOB, tachycardia, limitation to speech, wheeze.
3. Severe - agitated/distressed, marked WOB, UOAM/chest recession, tachycardia, difficult speech, wheeze.
4. Critical - confused/drowsy, maximal WOB, exhaustion, tachycardia, unable to speak, SILENT CHEST.

Question 11

Asthma - protocol

Answer 11

1. Mild - 1 x dose salbutamol (MDI/spacer) and R/V after 20min.
2. Moderate - O2T+H, 1 x dose salbutamol/20min for 60min and R/V after 3rd dose, 1 x dose ipratroprium/20min for 60min.
3. Severe - moderate PLUS, consider nebuliser, corticosteroids (oral prednisolone or IV methylprednisolone/hydrocortisone)
4. Critical - continuous nebulised salbutamol (5mg), nebulised ipratropium added every 20min for 60min, IV corticosteroids.
   * Salbutamol (100mcg/puff) = 6 puffs (<6yrs) or 12 puffs (>6yrs)
   **Ipratropium (21mcg/puff) = 4 puffs (<6yrs) or 8 puffs (>6yrs).

Question 12

Asthma - discharge criteria

Answer 12

1. Appropriate inhaler/spacer technique
2. Written asthma management plan
3. Follow-up with GP or paediatrician
4. Parent education - adherence, trigger avoidance.
5. Written information and resource contacts - e.g. asthma foundation, Kids Health info.