Respiratory Problems Flashcards
What are the signs of respiratory distress in children?
Increased RR and HR Nasal flaring Agitation Recession/retraction: - subcostal (milder) - intercostal (moderate) - sternal (severe) Accessory muscle use (scalene, SCM) and head bobbing (severe) Grunting - expiratory noise due to attempt to maintain PEEP (severe)
What is the differential for a cough in children?
Infection Asthma 2nd hand smoke Inhaled foreign body, aspiration CF Habit cough
What is the differential for wheeze in children?
Infection: bronchiolitis, pneumonia Allergic: asthma, milk allergy Transient early wheeze, viral wheeze Heart failure CF Inhaled foreign body +/- aspiration pneumonia Tracheomalacia (+/- stridor)
What is the differential for stridor in children?
Infection: croup, bacterial tracheitis, epiglottitis Anaphylaxis Inhaled foreign body Laryngomalacia Tracheomalacia
What is croup also called?
Acute laryngotracheobronchitis
Who normal gets croup?
Age 6 months - 3 years
Peak incidence age 2
Which organism most commonly causes croup?
Parainfluenza virus
What are the clinical features of croup?
1-4 day history of cough, rhinorrhoea + fever
–> barking cough and hoarseness
Symptoms worse at night
Stridor
Chest sounds may be normal, but may be decreased if severe airflow limitation
May be signs of respiratory distress/failure if severe
When should you consider admission for a child with croup?
Previous history of severe airway obstruction < 6 months old Immunocompromised Inadequate fluid intake Poor response to initial treatment Diagnosis uncertain Significant parental anxiety Moderate/severe croup or impending respiratory failure
What is the treatment for croup?
Single dose oral dexamethasone to all children with croup
Nebulised adrenaline if severe
What is bacterial tracheitis?
Bacterial infection of the trachea
Usually following viral URTI due to mucosal damage + local immune changes
What are the features of bacterial tracheitis?
Stridor
Purulent secretions
Mucosal necrosis + sloughing
High fever
How is bacterial tracheitis treated?
IV antibiotics
What causes epiglottitis?
Haemophilus influenzae type B
becoming less common due to vaccine
What are the features of epiglottitis?
Acute onset of high fever, sore throat + drooling
Stridor: soft + continuous (late sign suggesting airway obstruction)
Whispering
Tripoding
How is epiglottitis managed?
Anaesthetics, ENT + paediatrics
Do not disturb/upset child
Intubation + IV antibiotics
Which investigations can diagnose epiglottitis?
Laryngoscopy during intubation
Lateral neck xray –> thumb print sign
Blood cultures + swab once airway secure
What causes whooping cough?
Bordetella pertussis
–> highly contagious
What are the clinical features of whooping cough?
First URTI:
- rhinitis, irritability, sore throat, low grade fever, dry cough
Then paroxysmal phase:
- episodes of severe paroxysms of coughing followed by an inspiratory gasp producing the classic ‘whoop’ sound
- may be accompanied by red face, bulging eyes, vomiting or syncope
- often worse at night
Can last for up to 3 months
Which investigations are done for whooping cough?
If cough for < 2 weeks:
- nasopharyngeal aspirate or swab for culture
If cough > 2 weeks:
- anti-pertussis toxin IgG serology
FBC –> lymphocytosis
What is the treatment for whooping cough?
Macrolide antibiotic (clarithromycin or azithromycin) if duration of cough < 3 weeks \+ supportive management
Prophylactic Abx to all members of household if any one of them is high risk:
- infants with < 3 vaccine doses, pregnant > 32 weeks, work with infants or pregnant women
Who gets bronchiolitis and what is it caused by?
Children < 2 years
Most commonly caused by RSV
What are the symptoms of bronchiolitis?
Low grade fever Nasal congestion Rhinorrhoea Cough Feeding difficulties/dehydration
Which signs might be seen on examination of a child with bronchiolitis?
Tachypnoea Grunting Nasal flaring Intercostal, subcostal or supraclavicular recessions Bilateral fine end inspiratory crackles Expiratory wheeze Hyperinflated chest Cyanosis/pallor
How is bronchiolitis diagnosed?
Clinically
Nasopharyngeal aspirate or throat swab can confirm pathogen but not routinely recommended
CXR only if diagnostic uncertainty
What would be seen on CXR in bronchiolitis?
Hyperinflation Focal atelectasis Air trapping Flattened diaphragm Peribronchial cuffing
How is bronchiolitis managed?
Conservatively Suction secretions if causing distress or feeding difficulties Oxygen if sats < 92% Fluids if inadequate oral intake CPAP if impending respiratory failure
When should a child be admitted for bronchiolitis?
Apnoea Looks seriously unwell Respiratory distress Central cyanosis Oxygen sats < 92% Inadequate fluid intake/clinical dehydration
What is viral induced wheeze?
Wheeze following a viral infection such as bronchiolitis
What is the investigation/management for an inhaled foreign body?
CXR (but only 25% of foreign bodies radiopaque)
If location knows –> rigid bronchoscopy under GA to remove
If location unknown –> flexible bronchoscopy under sedation to find it –> rigid bronchoscopy under GA to remove
What are the presenting features of CF?
Recurrent pneumonia most common Neonatal meconium ileus Steatorrhea, rectal prolapse, small bowel obstruction, GORD, PUD Failure to thrive Clubbing Nasal polyps/sinusitis Male infertility Salty sweat Pancreatic failure
How is CF diagnosed?
Fitting clinical history
+ positive chloride sweat test
+ supported by identification of 2 disease-causing mutations
Other than CF, what are the causes of bronchiectasis in children?
Post-infectious Immunodeficiency Primary ciliary dyskinesia Post obstructive e.g. foreign body aspiration Congenital syndromes: - Young's syndrome - Yellow nail syndrome
What are the principles of management of CF?
MDT + patient/family education
Daily chest physiotherapy
Exercise
Creon (pancreatic enzymes)
Vitamins A, D, E (+K) - fat soluble vitamins
Regular sputum cultures + antibiotics (at least 2 weeks)
What are the respiratory complications of CF?
Allergic bronchopulmonary aspergillosis (ABPA)
Bronchiectasis
Pulmonary hypertension
Pneumothorax
Respiratory failure will eventually occur
Nasal polyps
What are the GI complications of CF?
Rectal prolapse Distal intestinal obstruction syndrome Liver disease: - cholestasis - gallstones - liver cirrhosis
What are the endocrine + other complications of CF?
CF related diabetes
Delayed puberty
Other:
- arthritis
- reduced bone mineral density
- sub/infertility
