Respiratory upper airway Flashcards
Common cold
assure is self limiting
2-3d Sx, should resolve within 2w
Rest, fluids, healthy diet
Paracetamol/ibuprofen
Sore throat (pharyngitis + tonsillitis)
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
Sore throat in children on specific drugs to watch out for
DMARDs - IC
Carbimazole can causes neutropenia
take FBC in both cases
When to offer medical Mx of sore throat in children
After confirming bacterial tonsillitis on RSAT
DO NOT prescribe for sore throat
amoxicillin (maculopapular rash if EBV infection)
PACES of sore throat
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
Scarlet Fever
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
Cx of scarlet fever
Suppurative: otitis media, throat abscess, sinusitis, strep. pneumonia, meningitis, endocarditis, NF, TSS
non-suppurative (autoimmune): rheumatic fever, strep glomerulonephriti
Acute otitis media
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
acute otitis media Mx
- No abx: most cases will self resolve, seek help if no improvement in 3d
- Back up Abx prescription: abx not needed immediately but if no improvement after 3d then use
- Immediate abx: seek help if deterioration
Amox 5-7d (clari2L)
Abx marginally reduce pain but no effect on hearing loss
Recurrent otitis media can lead to
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
Sinusitis in children <10d Sx
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
sinusitis in children >10d Sx
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
Croup in children Ix
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
Croup severity
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
Not admitted for Croup Mx
single stat dose oral dex (0.15mg/kg)
alternative: PO pred, inhaled beclometasone
Croup causing recession at rest
PO dex, pred or neb. steroids
Severe upper airway obstruction in croup Mx
neb. adrenaline w/oxygen will cause rapid but transient improvement
monitor closely
Summary of Croup Mx
stat PO dex (0.15mg/kg) for ALL children repeat at 12h if necessary Pred an alternative Emergency Mx: - high flow O2 - neb. adrenaline
PACES counselling of croup
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
Acute epiglottitis
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
Bronchiolitis in children when to call 999
Apnoea Seriously unwell Resp distress (grunting, RR >70) Central cyanosis persistent <92% stats OA
bronchiolitis consider referral
RR >60
<75% usual fluid intake
clinical dehydration`
Ix in bronchiolitis
Clinical Dx
SaO2
Nasopharyngeal aspirate for RSV (ELISA/RT-PCR)
consider CXR
Mx bronchiolitis
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
Recovery from bronchiolitis
mostly within 2wks
RARELY causes lasting damage (bronchiolitis obliterans)
Bronchiolitis prevention
palivizumab (mAb) reduces no. admission in high risk preterm infants
PACES counselling of bronchiolitis
Dx: viral infection of lungs, affects 1:3 children <1y
Should resolve within 2wks
P/I, fluids
RF: apnoea, distress should prompt visiting dr
Viral Episodic Wheeze
Ix: clinical
Mx: salbutamol inhaler, encourage stopping smoking
Instructions for using inhaler
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
Dosing of salbutamol in VEW
when wheezy/sob give them up to 10 puffs of salbutamol w/spacer every 4hrs
Safety net in VEW
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
If salbutamol ineffective in VEW?
intermittent LTRA, intermittent ICS
What is burst therapy
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
Summary of VEW
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
PACES counselling of VEW
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
Whooping Cough Ix
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
Pharm Mx of whooping cough
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)
Advice in whooping cough
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.
Summary of whooping cough
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
PACES of whooping cough
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
Foreign body inhalation Ix
CXR
Foreign body inhalation - conscious
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
Foreign body inhalation - unconscious
Secure airway immediately
unless body can be seen and removed from UA
remove FB as you would fot conscious
