respiratory infections Flashcards
what commonly causes tonsilitis and pharangitis?
- ussually viral
- can be caused by group A beta haemolytic strep
- can distringuish bacterial from viral if there is pleurelent exudate and lymphadenopathyh
what is the scoing system used to catagorise croup?
westly scorring system
which children should be admitted to hospital for croup?
Haemodynamically significant congenital heart disease
< 3 months old
Inadequate fluid intake < 50-75%
what is the causative organism of croup?
parainfluenza
how long does croup last?
5-6 days
what is the management of mild croup?
- discharged home with oral dexamethasone
what is the management of moderate/severe croup?
- admission to hospital
- oxygen
- oral dexamethasone
nebulised budenaside and adrenaline
intubation if fatigued
what are the complicatins of croup?
- airway obstruction
- superinfection= superimpostion with staphylococcus causing bacterial tracheitis
what ate the symptoms of croup?
- barking cough
- stridor
how is croup diagnosed?
- clinical diagnosis
what is the peak presenting age for epiglotisis?
6-12 years old
what are risk factors for epiglotisis?
Male gender
Unvaccinated
Immunocompromised
what is the causative organism in epiglotitis?
Haemophylis influenza B (HIB)
how to investigatew epiglotitis?
- senior paediatrician and anasthetics
- simply opn mouth- no instruments
- no bloods showing inflamatory markers until the airway has been secured
- can use laryngyscope
- neck radiograph will show thumb sign
what are clinical features of epiglotitis?
- stridpor
- tripod position
- drooling
- dyphagia
- pyrexial
what are complications of epiglotitis?
Airway obstruction: occurs secondary to significant upper airway inflammation and oedema
Mediastinitis: infection can track along the retropharyngeal space and involve the mediastinum, which is associated with a poor prognosis
Soft tissue involvement: cellulitis or abscess within the neck
how is epiglotisis managed?
- secure the airway
- nebulise adrenaline
- IV abx (broad spectrum like cephtriaxone)
dexamethasone is second line
how does whooping cough present?
- paroxysmal cough worse at night- lasting 4 days or more (infants may have apneoic episodes)
- leads to ‘whoop in between’
- post tussive vomiting
- cough may cause subconjunctival haemorrhage
- can have marked lymphocytosis
what is the causative organism for whooping cough?
gram negative bacteria- pertussis
whan are vaccines given against wooping cough?
infants are routinely immunised at 2, 3, 4 months and 3-5 years.
Newborn infants are particularly vulnerable, which is why the vaccination campaign for pregnant women was introduced
but this is not lifelong protection
how is whooping cough diagnosed?
per-nasal swab - may take several days or weeks to come back
PCR
which patients with whooping cough should be admitted?
- under 6 months
what is the management or whooping cough?
- pertussis is a notifiable disease- tell authorities
- use an oral macrolide abx- clarythromycin
- contacts to be given prophylaxis
- school exclusion for 48hrs after abx or 21 days from onset of symptoms
what are complications of whooping cough?
subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures
what age range is affected by bronchiolitis?
<1 … peak incidence 3-6 months, maternal IgG provides protection for newborn babies
what is the causative oragansim in bronchiolitis?
RSV
what are symptoms of bronchiolitis?
coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine inspiratory crackles (not always present)
feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
what is the management for bronchiolitis?
humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
suction is sometimes used for excessive upper airway secretions
when should you consider referring to hospital for bronchiolitis?
a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
clinical dehydration….How are their nappies?
