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Paeds > Respiratory upper airway > Flashcards

Respiratory upper airway Flashcards

1
Q

Common cold

A

assure is self limiting
2-3d Sx, should resolve within 2w
Rest, fluids, healthy diet
Paracetamol/ibuprofen

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2
Q

Sore throat (pharyngitis + tonsillitis)

A

Ix: temp, throat, swabs
Admit: dib, clinical dehydration, abscess, systemic illness, suspected rare cause (Kawasaki)
admit: only if needing IV fluids
Medical Mx: penicillin V 10d (2L clari)
Advice: fluids, salt water gargle, para/ibu
return to school after fever resolved, feeling well and ABx for 24hrs

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3
Q

Sore throat in children on specific drugs to watch out for

A

DMARDs - IC
Carbimazole can causes neutropenia
take FBC in both cases

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4
Q

When to offer medical Mx of sore throat in children

A

After confirming bacterial tonsillitis on RSAT

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5
Q

DO NOT prescribe for sore throat

A

amoxicillin (maculopapular rash if EBV infection)

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6
Q

PACES of sore throat

A

tonsillitis/pharyngitis is an inflammation of the upper airway/back of the mouth
need to take for 10d to totally eradicate organism
Avoid school until 24hr after Abx starting and child feels well
para/ibu, lozenges, gargling, diffllam

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7
Q

Scarlet Fever

A

notify HPT
ABx: pen V qds 10d (2L azithromycin), stay away from school for 24hrs after starting
P/I for analgesia/temp
Should settle in 1w
Rx for 10d to avoid acute glomerulonephritis and rheumatic fever

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8
Q

Cx of scarlet fever

A

Suppurative: otitis media, throat abscess, sinusitis, strep. pneumonia, meningitis, endocarditis, NF, TSS
non-suppurative (autoimmune): rheumatic fever, strep glomerulonephriti

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9
Q

Acute otitis media

A

Ix: temp, otoscopy
Admit: systemic inf., Cx (meningitis/facial nerve palsy), <3m w temp>38C
Advice: 3d-1w, P/I for pain, no evidence for antihistamines/decongestants
?medical management

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10
Q

acute otitis media Mx

A
  1. No abx: most cases will self resolve, seek help if no improvement in 3d
  2. Back up Abx prescription: abx not needed immediately but if no improvement after 3d then use
  3. Immediate abx: seek help if deterioration
    Amox 5-7d (clari2L)
    Abx marginally reduce pain but no effect on hearing loss
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11
Q

Recurrent otitis media can lead to

A

Glue ear (otitis media w/effusion)
Often asymptomatic except for possible reduced hearing
Eardrum dull and retracted. ?visible fluid level
2-7 most common
usually resolves spontaneously
Cx: conductive hearing loss impacting SAL
- offer grommets (benefits do NOT last longer than 12m
IF recurrence after grommet removal reinsert + adenoidectomy

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12
Q

Sinusitis in children <10d Sx

A

Refer: systemic infection, intra/periorbital Sx (cellulitis, displaced eyeball, double vision), intracranial Cx
<10 d Sx: NOT ABx
- explain is usually viral (2% Cx by bacterial infection)
- P/I
- nasal saline/decongestants an option
- seek help in 3wks or if systemically unwell

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13
Q

sinusitis in children >10d Sx

A

consider high dose IN CS 14d if >12yo (mometaosone) unlikely to alter Dx course, may help with Sx but carry SE

consider No or back-up Abx prescription (use after 7d or worsening Sx)
1L: Pen V (if allergic clari), L: co-amox

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14
Q

Croup in children Ix

A 
do NOT I examine throat as can worsen dib
Westley score:
- chest wall retraction, stridor, cyanosis, LOC, air entry
max score 17
Mod: 3-5
Sev: 6-11
Impending resp failure: 12
NB. 75% is caused by para-influenza
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15
Q

Croup severity

A

Mild: barking cough but NO stridor or recession at rest
Moderate: barking cough w/stridor and sternal recession at rest, NO agitation/lethargy
Severe: barking cough w/stridor and sternal/IC recession a/w agitation or lethargy
Impeding resp failure: increasing obstruction, recessions, chest wall asynchrony and abdominal breathing, fatigue, pallor/cyanosis. reduced LOC, RR >70
ADMIT ALL WORSE THAN MILD

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16
Q

Not admitted for Croup Mx

A

single stat dose oral dex (0.15mg/kg)

alternative: PO pred, inhaled beclometasone

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17
Q

Croup causing recession at rest

A

PO dex, pred or neb. steroids

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18
Q

Severe upper airway obstruction in croup Mx

A

neb. adrenaline w/oxygen will cause rapid but transient improvement
monitor closely

19
Q

Summary of Croup Mx

A 
stat PO dex (0.15mg/kg) for ALL children
repeat at 12h if necessary
Pred an alternative
Emergency Mx:
- high flow O2
- neb. adrenaline
20
Q

PACES counselling of croup

A

Dx: infection of airways, common, viral. Will improve over 48hrs and steroids will help reduce inflammation
If worse come back
If blue/pale/red. LOC call ambulance
P/I if distressed
Fluids
Check on child at night when cough is worse

21
Q

Acute epiglottitis

A

suspected -> URGENT hospital admission and Mx required
ICU (secure airway (if sev. ETT) and give supplemental O2)
Blood culture
IV cefriaxone
consider steroids/adrenaline
recovery 2-3days
Prophylactic rifampicin to household contacts

22
Q

Bronchiolitis in children when to call 999

A 
Apnoea
Seriously unwell
Resp distress (grunting, RR >70)
Central cyanosis
persistent <92% stats OA
23
Q

bronchiolitis consider referral

A

RR >60
<75% usual fluid intake
clinical dehydration`

24
Q

Ix in bronchiolitis

A

Clinical Dx
SaO2
Nasopharyngeal aspirate for RSV (ELISA/RT-PCR)
consider CXR

25
Q

Mx bronchiolitis

A

Humidified o2 supplmentation if sats persistently below 92%
CPAP if impending resp failure
Upper airway suction if secretions (definitely perform if apnoea)
Fluids by NG tube
Supportive
RSV highly infectious so infection control

26
Q

Recovery from bronchiolitis

A

mostly within 2wks

RARELY causes lasting damage (bronchiolitis obliterans)

27
Q

Bronchiolitis prevention

A

palivizumab (mAb) reduces no. admission in high risk preterm infants

28
Q

PACES counselling of bronchiolitis

A

Dx: viral infection of lungs, affects 1:3 children <1y
Should resolve within 2wks
P/I, fluids
RF: apnoea, distress should prompt visiting dr

29
Q

Viral Episodic Wheeze

A

Ix: clinical
Mx: salbutamol inhaler, encourage stopping smoking

30
Q

Instructions for using inhaler

A

expiry date
shake it
insert into end of spacer
administer 1 puff into spacer
Child breathes slowly and deeply for 5-10 breaths (10 if <2)
NB if spacer is whistling means breathing too quickly
Clean spacer once per month using soapy water

31
Q

Dosing of salbutamol in VEW

A

when wheezy/sob give them up to 10 puffs of salbutamol w/spacer every 4hrs

32
Q

Safety net in VEW

A

If not responding or improving after 10 puffs or if needing it again seek help
If they continue to be wheezy 48hrs after discharge come back
If experiencing Sx between viral illnesses they are increased risk of asthma

33
Q

If salbutamol ineffective in VEW?

A

intermittent LTRA, intermittent ICS

34
Q

What is burst therapy

A

in viral induced wheeze
10 puffs of salbutamol w/spacer
Assessed for response to treatment
If they can last 4hrs w/o Sx returning they can be d/c
Given a weaning regime for salbutamol inhaler w/spacer

35
Q

Summary of VEW

A 
Mx is symptomatic
1L: SABA or anticholinergic via spacer
2L: Intermittent LRTA/ICS/both
no need for PO pred
multiple trigger wheeze: trial of ICS or LRTA for 4-8wks
36
Q

PACES counselling of VEW

A

Dx: narrowing of airways due to viral infection in chest causes sound
Mx: inhaled medicine will open the airways, 4hr monitoring and ?d/c,
D/c: salbutamol w/spacer:
- 10 puffs through spacer max every 4hrs
- If no response after 10 seek help
- if Sx 48hrs after d/c seek help

37
Q

Whooping Cough Ix

A 
Notify HPU
Culture NP aspirate
PCR NP aspirate
Serology useful in later stages
FBC
Admit:
<6mo or acutely unwell
Significant breathing difficulties
Cx like seizure, pneumonia
ISOLATE
38
Q

Pharm Mx of whooping cough

A

If admission NOT needed: Abx if onset of cough is within 21: (macrolide)
- <1m = clari
- >1m+nonpregnant = azithromycin
- pregnant = erythromycin (recommended from 36w to reduce transmission)
Co-amox used if macrolides CI (not in pregnany adults or babies <6w)

39
Q

Advice in whooping cough

A

Rest, fluids, P/I
Despite Abx pts are likely to cause non infectious cough that may take weeks to resolve
Avoid school until 48hrs after Abx started or 21d after cough onset if no Abx
Once acute illness dealt with advise immunisations
close contacts should receive macrolide proph.

40
Q

Summary of whooping cough

A

Ix: culture/PCR for B pertussis, serology
Admit: <6m, unwell
HPU
Oral macrolide if cough <21d
Contact prophylaxis
avoid school for 48hrs after commencing abx

41
Q

PACES of whooping cough

A

Dx: cough that may last for a few weeks, will become non-infectious if Abx
Rarely seen, imms. concern?
Can become reinfected despite prev. infection
Abx will treat but cough likely to persist
Exclusion until 48hrs after Abx

42
Q

Foreign body inhalation Ix

A

CXR

43
Q

Foreign body inhalation - conscious

A 
coughing 
external manoeuvres:
- back blows x5
- abdo thrusts x5 (not infants)
removal of FB:
- (1L) rigid/flexible bronchoscopy 
(rigid bronchoscopy if stridor, asphyxia, object on CXR, Hx of FBI a/w unilateral dec. breath sounds, localising wheeze, obstructive hyper-inflation or atelectasis)
   done with conscious sedation or GA
(2L) - surgery, thoracotomy
44
Q

Foreign body inhalation - unconscious

A

Secure airway immediately
unless body can be seen and removed from UA
remove FB as you would fot conscious

Paeds (23 decks)

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