Respiratory - ENT Flashcards
What are the clinical features of epiglottits?
- high fever, very ill, toxic looking child - an intensely painful throat that prevents child from speaking or swallowing, saliva drools down the chin- soft inspiratory stridor and rapidly increasing respiratory difficulty over hours - the child is sitting immobile, upright, with an open mouth to optimise the airway
What are the causes of upper airway obstruction?
viral laryngotracheobronchitis - croup - COMMON RARE causes:epiglottitis bacterial tracheitis laryngeal or oesophageal foreign body allergic laryngeal angioedema etc.
How can you differentiate between the other causes of airway obstruction and epiglottitis?
Croup Epiglottitis Onset over days over hoursPreceding coryza yes no Cough severe, barking absent or slight Able to drink yes noDrooling saliva no yesAppearance unwell toxic, very ill Fever <38.5 >38.5Stridor harsh rasping soft whisperingVoice, cry hoarse muffled, reluctant to speak
How does acute otitis media present?
ear pain and fever
How does acute otitis media appear on examination?
examine tympanic membrane - acute OM = bright red and buldging - pus in external canal if perforated
How is acute otitis media treated?
- simple analgesia - most resolve spontaneously - Abx shorten pain duration but don’t reduce risk of hearing loss - amoxicillin
What organism commonly causes otitis media?
virus - RSV, rhinovirusbacteria - pneumococcus, H.influenza common at 6-12 months
How does otitis media with effusion present? (glue ear)
possible decreased hearing asymptomatic
What is seen on examination in patients with otitis media with effusion?
ear drum is dull and retracted may see a visible fluid level flat trace on tympanometry
How is otitis media with effusion treated?
Grommets no effective medical treatment adenoidectomy may be helpful if recurrent OME with hearing loss, obstructive sleep apnoea
When is otitis media common?How does it effect these children?
2-7 year olds most common cause of conductive hearing loss in children this can lead to speech and learning difficulties if recurrent with hearing loss
How does tonsillitis present?
inflammation of tonsils purulent exudate if bacterial may see headache, apathy, abdo pain, cervical lymphadenopathy and white exudate
What investigations can be done if you suspect tonsillitis?
Culture
How is tonsillitis managed?
ABx - penicillin, erythromycin avoid amoxicillin in glandular fever as causes rash
What are the common pathogens causing tonsillitis?
group A B-haemolytic streptococcus, EBV (infective mononucleosis)
When is a tonsillectomy considered?
quinsy (abscess) recurrent severe tonsillitis sleep apnoea
What is pharyngitis?
Sore throat Pharynx and soft palate are inflamed usually viral could be group A B-haemolytic strep in older children
How does sinusitis present?
Most commonly maxillary - may get secondary bacterial infection –> pain and swelling
How is sinusitis treated?
ABx, analegesia topical decongestants
What conditions are URTIs?
common cold (coryza) sore throat (pharyngitis, including tonsillitis) acute otitis media sinusitis (relatively uncommon) children often present with a combination
How does the common cold (coryza) present?
clear or mucopurulent nasal discharge nasal blockage
How is the common cold managed?
self limiting
What organism commonly causes coryza?
rhinoviruscoronavirus RSV
When is a child considered to have a fever?
> 38 degrees C
How should a fever be treated?
should be assessed for an underlying cause paracetamol/ibuprofen should be used
When is hospital admission required with an URTI?
rarely required but may be necessary if feeding and fluid intake is inadequate
How does viral croup present?
barking cough stridor hoarseness may see fever and coryza before difficulty breathing symptoms are often worse at night
How is viral croup investigated and treated?
look for oedema of subglottic area oral dexamethasone NEB steroids helpIf severe NEW epinephrine with oxygen
What commonly causes viral croup? In what age group is it common?
95% of all laryngotracheal infections most likely parainfluenza peaks in 2 year olds admission threshold lowest in <12 months due to narrow airway
How is epiglottitis managed?
urgent admission intubate cultures IV ABx - cefuroxime Prophylactic rifampicin for household contacts
What organisms commonly causes epiglottitis?
H. influenza B Reduced by Hib vaccine - now rare NB if child cries will lose airway
What are the clinical features of bacterial tracheitis?
high fever rapid airway obstruction thick airway secretions caused by staph aureus
How is bacterial trracheitis managed?
IV ABx Intubation and ventilation if required
Outline the basic management of acute upper airway obstruction?
- reduce anxiety - be calm and confident - observe for signs of hypoxia or deterioration - agitiation, fatigue, drowsiness - provide oxygen if required and tolerated- do not examine the throat with a spatula - oral, NEB or IV steroids are beneficial in croup - if severe administer NEB epinephrine and contact anaesthetist- tracheal intubation if respiratory failure develops
What is the immediate danger with burns and smoke inhalation?How should this be managed?
check for airway burns - soot in nasal and oral cavities - cough, hoarseness, stridor - coughing up black sputum - difficulty breathing - scorched eyebrowns or hair early intubation important if evolving airway is swelling as may become impossible with progressive obstruction of the airway
