Respiratory Presentations - TTN, CDH, Pulmonary hypoplasia, Meconium aspiration syndrome, Laryngomalacia, Asthma, Bronchiolitis, Viral wheeze, Pneumonia, Epiglottitis, Croup, Pertussis Flashcards
Transient tachypnoea of the newborn
-what is it
-risk factor
-presentation
-investigations
-management
Most common cause of respiratory distress in the newborn
-delayed resorption of fluid in the lungs
Common in CSection as lung fluid isn’t squeezed out
CXR - hyperinflation of lungs, fluid in horizontal fissure
Observation, supportive care - settles in 2days
Supplementary O2
Congenital diaphragmatic hernia
-what is it
-presentation
-investigation
GI herniates through diaphragm into thoracic cavity due to incomplete formation of the diaphragm
-limits space for lung development, can lead to pulmonary hypoplasia, pulmonary HTN
Can be detected on antenatal US
Postnatal presentation
-difficulty breathing
-concave abdomen
-reduced breath sounds
Pulmonary hypoplasia
-what is it
-causes
Undeveloped lungs in neonates
-oligohydramnios
-congenital diaphragmatic hernia
Meconium aspiration syndrome
-what is it
-risk factors
-presentation
Respiratory distress in newborn as result of meconium in trachea
Risk factors
-maternal HTN
-preeclampsia
-chorioamnionitis
-smoking
-substance use
-post term delivery
Respiratory distress
-cyanosed
-high RR
Laryngomalacia
-what is it
-presentation
-investigations
-management
Flaccid larynx which collapses when breathing
STRIDOR - intermittent
-when supine, feeding or agitated
Worsen in severity during 1st 8 months, resolve by 18-24th months
Rare - Resp distress, failure to thrive, cyanosis
SaO2, blood gases taken if desaturating
If severe or diagnostic uncertainty - laryngoscopy, bronchoscopy
Majority are self limiting
Symptomatic relief - hyperextension of neck when stridulous
If severe - surgery
-tracheostomy, laryngoplasty, exicision of redundant mucosa
Asthma diagnosis
-5-16
-U5
5-16
Spirometry with BDR test
FeNO if
-normal spirometry
-obstructive spirometry (U70%) + -ve BDR
FeNO +ve = 35ppb+
BDR +ve = 12%+ improvement
U5
Clinical judgement
Bronchiolitis
-causative organism
RSV
-U1
-higher incidence in winter
More serious if premature, congenital heart disease, CF
Flu-like
Mild fever
Dry cough
SOB
Wheeze, fine inspiratory crackles
Feeding difficulties with increasing SOB
999 if
-apnoea
-appears seriously unwell
-severe resp distress - grunting, marked chest recession, RR 70+
-central cyanosis
-SaO2 U92% RA
Consider if
-RR 60+
-difficulty breastfeeding/oral intake
-clinical dehydration
Immunofluorescence of nasopharyngeal secretions
SUPPORTIVE
-humidified O2
-NG feed if oral intake insufficient
-suction for upper airway secretions
Viral wheeze
-what is it
-classification
-presentation
-management
Most common diagnosis in paeds, especially nursery
Episodic VW - symptom free between episodes
Multiple trigger VW - wheeze triggered by viral + other causes (exercise, allergens, cigarette smoke)
Smoker parents - advised to stop
Episodic - symptomatic treatment
1st line - spacer with SABA/SAMA
2nd line - montelukast/intermittent ICS or both
Multiple trigger wheeze
ICS/LRTA trial for 4-8wks
Pneumonia
-causative organism
-presentation
-investigations
-management
S pneumonia
High fever
DIB
Cough
Irritable, more tired than usual
Xray
1st line - amoxicillin
2nd line - macrolides (or if mycoplasma, chlamydia suspected)
Acute epiglottitis
- causative organism
- presentation
- diagnosis
- management
HiBs
- rapid onset, flulike
- stridor
- drooling of saliva
- tripod
Diagnosis made by direct visualisation
- Lateral Xray - thumb sign
- PA Xray - steeple sign
IMMEDIATE SENIOR INVOLVEMENT
- intubate if needed
- O2, IV ABx
Croup
- causative organism
- presentation
- diagnosis
- management
Parainfluenza - most common in U3
- stridor
- barking cough
- flulike
-increased work of breathing
Clinical diagnosis
CXR
PA - steeple sign
L - thumb sign
Medical - PO STAT dexmeth 0.15mg/kg regardless of severity
Emergency treatment
-high flow O2
-adrenaline nebs
Admit if
Moderate or severe
-audible stridor at rest
-frequent barking cough
-increased works of breathing
U3 months
Known upper airway abnormalities
Uncertainty about diagnosis
Pertussis
-causative organism
-presentation
-diagnostic criteria
-diagnosis
-management
-complications
G-ve bordetella pertussis
Catarrhal phase - 1-2 weeks
-similar to URTI
Paroxysmal phase - 2-8wks
-severe coughing spells, ended by vomiting/central cyanosis
-apnoea spells
-inspiratory whoop
Convalescent phase - weeks - months
Diagnosed if
-acute cough lasting 14days+ without another apparent cause with the following features
-paroxysmal cough
-inspiratory whoop
-post-tussive comiting
-undiagnosed apnoea attacks
Nasal swab/PCR and serology
U6months => admit
PO macrolide if cough started within 21days
Household contacts given prophylactic ABx
School exclusion
-48hrs after starting ABx
-21 days from onset if no ABx
NOTIFIABLE DISEASE
Subconjunctival hemorrhage
Pneumonia
Bronchiectasis
Seizures
Asthma assessment of acute attacks
-moderate
-severe
-life threatening
Moderate
-SaO2 - 92%+
-PEF - 50%
-no clinical features of severe asthma
Severe
-SaO2 - U92%
-PEF - 33-50%
-HR
5+ - 125+
2-5 - 140+
-RR
5+ - 30+
2-5 - 40+
-Too breathless to talk/feed
-Acccessory neck muscles
Life threatening
-SaO2 - U92%
-PEF - U33%
-silent chest
-poort resp effort
-agitation
-altered consciousness
-cyanosis
Management of mild/moderate acute asthma
BD
-1 puff every 30-60s up to max 10 puffs
-if not controlled, repeat B2ag, refer to hospital
Pred (3-5days)
2-5 - 1-2mg/kg OD (max 40mg)
5+ - 1-2mg/kg OD
Management of severe, life threatening asthma
TRANSFER TO HOSPITAL IMMEDIATELY
