with subglottic narrowing and normal epiglottis (steeple sign)

if mild cases – supportive. (+/- mist) if stridor at rest -> O2, racemic epinephrine nebulizer, dexamethasone "go outside in the cold air"

Respiratory system and infections Flashcards by Lauren Ames

stridor

upper airway

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wheeze

lower airway

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rhonchi

low note, fluid in big airways

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crackles/rales

fluid or atelectasis in small airways (fine sounds)

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foundation of lung studies

CXR

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what would a barium swallow show us

TEF, GER, vascular rings

Good if you wanted to see if a structure was compressing the trachea

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what will a lung CT show us

parenchymal changes , lung interstitium, Masses

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what will laryngoscopy/bronchoscopy show us

obstructions and malacia, foreign bodies, intubation

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bugs for croup

Parainfluenza (RSV, influenza, adenovirus, roseola,mycoplasm pneumoniae)

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when/who gets croup

Fall and early winter, younger children(6mo-3yr)

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Acute inflammatory disease of the larynx - common

Acute Inspiratory Stridor

croup

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xray with croup

with subglottic narrowing and normal epiglottis

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testing for croup

Viral swab for respiratory viruses

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treatment for croup

if mild cases – supportive. (+/- mist)

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how do you know when a kid with croup can go home?

If symptoms resolve within 3 hrs and there is no stridor at rest – can go home. If recurrent nebs (Q 20 min > 1-2 hrs) needed, hospitalize

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bacterial croup

bacterial tracheitisInvasion of bacteria into mucosa of pt with viral croup

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cause of bacterial tracheitis

Staph Aureus ( H flu, S. pyogenes, Morax cat)

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Inflammatory edema, purulent secretions,
High fever, toxic, severe obstruction
Severe life threatening from of laryngotracheobronchitis

bacterial tracheitis

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treatment for bacterial tracheitis

Hospitalization and monitoring, suctioning, hydration. IV ABX for Staph Aureus. More likely to need intubation.

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bugs for epiglottitis

Hflu type B ( deceased incidince since HiB immunization) – now GAS , and Staph A

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Kid comes in with inspiratory stridor
Resp distress
Drooling
Sudden onset

epiglottitis

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Kid comes in, you think it is epiglottitis. What do you do first?

Emergency – anticipate intubation

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Epiglottitis x ray

Lateral neck xrays. “Thumb sign” means thickened epiglottis

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most common cause of stridor in infants

laryngomalacia-Underdeveloped cartilaginous structures

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kid comes in w stridor-Worse supine, with activity, with infection, during feedings

laryngomalacia

Congenital or trauma/injury | Hoarseness, aspiration and high pitched stridor

vocal cord paralysis

Congenital or from intubation Mild to severe with serious obstruction of airway Stridor after extubation Suspect in Pt with recurrent croup

subglottic stenosis

``` stridor or wheeze Airway compression (PDA, abberant inominant artery) ```

vascular ring or sling

tracheomalacia and vascular ring: upper or lower airway disorder?

Could be EITHER!

acute lower airway obstruction

asthma, bronchiolitis , foreign body

progressive lower airway disorders

CF or bronchiolitis obliterans

pt with chronic wheeze, pneumonias, asymmetric chest sounds presents with sudden cough, wheeze of respiratory distress

Foreign body- lower resp tract

treatment foreign body upper resp tract

Heimlich (over 1)Child < 1 turn over onto their chest and 5 measured back blows between the shoulder blades, followed by 5 chest compressions if needed – repeat

treatment foreign body lower resp tract

Beta adrenergic nebs and CPT (pounding)

organism for bronchiolitis

RSV. (Human metapneumovirus, Parainfluenza, influenza, adenovirus)

leading cause of hospitalization of infants

bronchiolitis

a young infant presents with cough, coryza, rhinorrhea… over 3-7 days to noise raspy breathing and audible wheeze, and apnea. What do you think?

bronchiolitis

time for bronchiolitis

late winter months from November through March

x ray for bronchiolitis

Hyperinflation | Increased interstitial markings

monoclonal antibody for RSV

synagis

most common cause of pneumonia in children

VIRAL

bacterial cause of pneumonia

strep pneumo

bugs for viral pneumonia

RSV , parainfluenza , influenza A and B, human metapneumovirus

URI prodrome + wheezing and stridor +/-fever | Myalgia, malaise, headache

viral pneumonia

viral pneumonia CXR

perihilar streaking, increased interstitial markings or patchy bronchopneumonia

therapy for viral pneumonia

supportiveIdentify at risk pt (BPD, asthma, RSV, CHD) for hospitalization (antibiotics commonly started)

CXR bacterial pneumonia

Patchy infiltrates, atelectasis, hilaradenopathy, pleural effusions. Possibly complete lobar consolidation in infants

treatment for bacterial pneumonia

Amox, augmentin, Erythromycin Cefuroxime | Occurs anytime of year

common time of year for bacterial pneumonia

ANY TIME

1-5 year old kids with pneumonia common bugs

Most common causes are respiratory syncytial virus (RSV) in infants , respiratory viruses (parainfluenza viruses, influenza viruses, adenoviruses)

kid older than five, common pneumonia bugs

most common is Mycoplasma pneumoniae

principle causes of atypical pneumonia

M. pneumoniae and Chlamydophila pneumoniae

which age is affected by strep pneumo for pneumonia?

occurs in children of any age, outside the neonatal patient

bug for pertussis

Whooping Cough due to Bordetella pertussis

how and when is pertussis spread

Highly contagious , July – October (via cough) | Incubation 6 days – most contagious

three stages of pertussis

Catarrhal : URI 1-2 weeks Paroxysmal : Staccato cough with inspiratory whoop and post tussive vomiting 2-4 weeks Convalescent: Dry cough 1-2 weeks

gold diagnostic standard pertussis

Culture from NP Swab gold standard

treatment for pertussis

Treatment Erythromycin /azithromycin– treat family

"classic pertussis" common in what age

1-10 years old

adolescent presentation with pertussis

Adolescents present with prolonged bronchitis, persistent non-productive cough – often begins as a URI. Don’t whoop but may have paroxysms Cough can last weeks to months

how can young infants present with pertussis

apnea

chronic progressive disease that can present with protein and fat malabsorption (failure to thrive, hypoalbuminemia, steatorrhea), liver disease (cholestatic jaundice), or chronic respiratory infection

Diagnostic presentation of newborn with CF

meconium ileus | Severe intestinal obstruction from inspissation of tenacious meconium in terminal ileum

how do you diagnose CF

sweat test..It is positive (elevated sweat chloride > 60 mEq/L) in 99% of patients with CF

PE: digital clubbing , chronic sinusitis, nasal polyposis and failure to thrive: Frequent bulky foul smelling greasy stools Protein and fat malabsorption Frequent pneumonias / bronchitis

treatment of CF

manage infections ( may need IV antibiotics or longer courses of antibiotics) Pancreatic enzyme replacement ADEK

Congenital malformation: non functioning pulmonary tissue that does not communicate with tracheobronchial tree. Blood supply from anomalous blood supply

pulmonary sequestration

``` Congenital malformation: decreased in alveolar number and airways Lack of space , achondroplasia or CDH (1:2200) Low amniotic fluid Low amount of fetal breathing ```

pulmonary hypoplasia

Congenital malformation: 95% congenital cystic lung disease, large airspaces R=L cystic tissues CXR . Surgery

CCAM

thanatophoric dwarf at risk for

lung hypoplasia

elevation of part or all of diaphram Striated muscle replaced with connective tissues Congenital , acquiried If large, paradoxical movement of diaphram Surgery

eventration of the diaphragm

Herniation of abdominal contents into chest

CDH

depression of sternum/ anterior chest wall

pectus excavatum

protrusion of sternum/ anterior chest wall – more common in males

pectus carinatum

NM disease can cause breathing problems how?

poor air entry, or poor diaphram excursion

type I alveolar cells

form the structure of an alveolar wall

type II alveolar cells

secrete surfactant

surfactant deficiency in premies

RDS

treatment for RDS

give surfactant via ETT (endotracheal tube)

this disease is a sequel of surfactant deficiency. You still need oxygenation at 1 month of age

Chronic lung disease, or BPD

ALTEs in infancy

Apnea / color change / decreased muscle tone / emesis/ choking/ gagging

most common frequent associated problems with ALTE

GER and laryngomalactia most common (50%)

Most deaths in < 6 mo Most number of deaths ages 2-4 months Most deaths between midnight and 8am, and in winter

SIDS

3:2 males to females | Risk factors: Low birth weight, smoking, teenage mother, drug addicted mother

SIDS