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Paediatrics > respiratory distress, airway emergencies, and cough > Flashcards

respiratory distress, airway emergencies, and cough Flashcards

1
Q

upper airway obstruction signs

A 
snoring
drooling
stridor
facial edema
neck mass
hoarseness
barky cough
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2
Q

upper airway obstruction causes

A

foreign body
edema (croup, anaphylaxis)
mucous/debris (croup)
anatomic abnormality (vascular rings)

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3
Q

lower airway obstruction causes

A

pneumonia
bronchiolitis
asthma

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4
Q

lower airway obstruction signs

A

prolonged expiratory phase, wheeze, hx of atopy

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5
Q

ddx for stridor

A 
laryngomalacia (infants)
tracheomalacia (expiratory)
vascular rings
croup
epiglottitis
bacterial trachiectasis
retropharyngeal abscess
peritonsilar abscess
foreign body
angioedema
GERD
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6
Q

croup presentation

A

peaks 7-36mo

viral prodome, sudden onset barky cough
stridor
resp distress

dx = clinical but xray would show steeple sign

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7
Q

treatment of croup

A

dexamethasone

if mod-severe then add epinephrine nebulizer

if severe, supplemental O2, fluids, etc

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8
Q

foreign body aspiration presentation, investigations, treatment

A

sudden onset, often biphasic stridor, decreased air entry, oral secretions

consult ENT immediately for scope

CXR: air trapping, lung remains “inflated” in expiratory xray (do insp + exp)

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9
Q

bacterial trachiectasis presentation + diagnosis

A

superimposed on viral infection

  • fever, stridor, cough, resp distress
  • poor response to epi neb + steroids
  • xray - steeple sign
  • definitive dx: bronchoscopic (exudates, membranes, membranes)
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10
Q

bacterial trachiectasis managment

A

fluids, antibiotics, +/- antivirals +/- bronchoscopy to clear secretions +/- intubation

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11
Q

Epiglottitis organisms

A

H influezna, S aureaus, GAS

rarer since HiB vaccine

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12
Q

epiglottitis presentation

A

URTI –> sore throat, high fever –> drooling, dysphagia, dysphonia, distress, “doom”

toxic
tripoding
stridor
tender at hyoid
tachycardia
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13
Q

epiglottitis management

A
  • don’t examine oropharynx
  • call ENT immediately
  • intubate
  • cultures: blood +/- epiglottic
  • IV cefuroxime or ceftriaxone

Xray *don’t do, wastes time: thumbprint, ballooning hypopharynx

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14
Q

DDx for wheeze

A

common

  • bronchiolitis - 1st episode
  • asthma - recurrent
  • pneumonia - fever, cough, malaise
  • GERD + aspiration

uncommon

  • CF
  • foreign body - sudden, wheeze, cough, DAE
  • bronchopulmonary dysplasia - hx of mech vent / O2, premie

rare:

  • mediastinal mass
  • CHF - /w FTT
  • bronchiolitis obliterans
  • tracheobronchial abnormalities
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15
Q

bronchiolitis description

A

usually RSV, <2y

URTI –> resp distress

worsens over first 72h, lasts 2-3 wks

low-pitch wheeze +/- crackles

resp distress between coughing (vs in pertussis they’re ok)

+/- post-tussive vomiting

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16
Q

diagnosing bronchiolitis

A

clinical dx

pulse O2, NP swab if hospitalized

CXR + bloodwork not needed unless unsure if another dx

CXR: airway disease, hyperinflation, +/- atelectasis (vs bacterial pneumonia = consolidation without airway disease)

17
Q

treatment for bronchiolitis

A

O2 (sats >90%)
IVF PRN

can try: epi neb, nasal suctioning, combined epi + dex

don’t: antibiotics, antivirals, hypertonic saline/mist, chest physio, corticosteroids, salbutamol (unless older and hx atopy, stop if no response)

18
Q

asthma exacerbation treatment

A

O2 to keep >90%

mild: salbutamol 4-8puffs, q20min x3 in first hour, repeat if poor response,
- discharge if ok 2-4h after last dose

mod: salbutamol and PO steroids
severe: salbutamol, ipratroprium /w first 3 doses, steroids PO/IV

critically ill / no response: add MgSO4, IV salbutamol, ICU

discharge instructions: ventolin 4-8 puffs q4h for 1-2 days, complete steroid course (5d), fluticasone for 3 weeks daily or throughout season if freq exacerbations

return if using ventolin >q4h

19
Q

preschool asthma diagnosis

A

can diagnose after 2 episodes treated /w clear improvement

if 1 episode and has clear improvement, or 2+ reported episodes of asthma-like symptoms

  • freq exacerbations or a mod-severe: ICS x3 mo + SABA PRN
  • if not monitor +/- 3 mo SABA PRN trial

if improves, dx asthma, if unclear, stop stop and see if deteriorates

20
Q

Diagnosing asthma in older kids

A

if 6+ can do PFT

reduced FEV1/FVC and increased FEV1 after bronchodilator

<0.9 predicted and post is >12% increase

for adults
<0.8% pred, >12% AND 200ml increase post

21
Q

asthma treatment in 6 - 11 year olds

A

Intermittent (symptoms <2x/wk and night <2/mo):
SABA on demand only:

  • Low dose ICS
  • Medium dose ICS
  • LTRA or LABA (most pick LTRA first)

specialist consult

  • Add the other one of the above
  • High dose ICS with LABA and LTRA
  • Anti-IgE therapy
  • chronic oral prednisone

once controlled, step down to min needed

22
Q

asthma treatment for 12+ year olds

A

intermittent sx: SABA on demand only

  • Low dose ICS
  • : Add LABA to low dose ICS
  • Add LTRA or increase to medium ICS with LABA
  • Add the other one of above
  • High dose ICS with LABA and LTRA
  • Anti-IgE therapy
  • chronic oral prednisone
23
Q

asthma “good control”

A
  • day sx <4d/wk
  • night sx <1d/wk
  • no activity limitation
  • rescue inhaler <4x / week
  • mild, infreq exacerbations
  • FEV1 or PEF > 90% personal best
  • PEF diurnal variation <10-15%
24
Q

Pertussis presentation

A

URTI sx 1-2 wks first

forceful paroxysms of cough 4-6wks, /w whoop after (not in infants)

convalescent stage: less severe cough, can last months

complications: feeding difficulty (babies), apnea

25
Q

diagnosing pertussis

A

NP swab (PCR or culture)

blood serology

26
Q

treatment for whooping cough

A

azithromycin if <3wks of kids <6mo

27
Q

cystic fibrosis symptoms

A

resp: chronic prod cough, infections, low O2, broncheictasis, pneumothorax, hemoptysis, PHTN / CHF, chronic sinusitis, nasal polyposis

GI: protein + fat malabsorption (pancreas), FTT, mec ileus, obstruction, jaundice, focal biliary cirrhosis, rectal prolapse, recurrent pancreatitis

other: DM, clubbing, low Na, low Cl / acidosis, ADEK deficiencies, dermatitis, Zn deficiency, male infertility, mucous obstruction of cervix

28
Q

testing for CF

A

immunoreactive trypsinogen = newborn screen

if positive, DNA test

if mutations, sweat chloride test to confirm

29
Q

obstructive sleep apnea age + sx

A

peaks 2-8

enlarged tonsils or adnenoids, obesity in older kids

snoring, gasping, apnea, mouth breathing, nasal obstruction, increased WOB, diaphoresis, neck hyperflexion at night, fatigue, FTT, poor school performance

30
Q

diagnosing OSA

A

polysomnogram

31
Q

treatment OSA

A

tonsillectomy or adenoidectomy

if obese & surgery ineffective: weightloss, CPAP

Paediatrics (23 decks)

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