resps Flashcards
diff with kids resps vs adult resps
Small airways
Disproportionate tongue to mouth
Undeveloped supporting cartilage/ breathing muscles
Less alveoli (develop from 20 mil-200 mil over 1st 3 years of life)
Flexible larynx- prone to spasms
Presence of Tonsils & Adenoids
Large head, small neck and mandible
resps rate
infants toddler preschooler school age adolescents
infants 30-60 toddler 24-40 preschooler 22-34 school age 18-30 adolescents 12-16
URTI
Average 6-8 colds per year (1/month, mostly Sept-April)
Primarily viral
Miserable, snotty, feverish
Symptoms last average 14 days
Common complications – AOM, pneumonia, asthma exacerbations, sinusitis (older age)
URTI s/s
Rhinorrhea –yellow or green discharge not necessarily bacterial
Cough – often worse at night or upon rising (clearing secretions)
oral intake – more concerned with dehydration rather than solid intake
Congestion – ask if “wet” or “dry” sounding cough versus “productive” cough
URTI tx
Reassure Parents!!! Most of the time self-limiting
Acetaminophen or Ibuprofen - increase mood increase fluid intake & easier to truly assess child (i.e grumpy child vs. very ill child)
increase Fluid intake (small amounts frequently)
“Prescribe” homemade tea - Warm H20, Fresh Ginger, Lemon, honey (>12mos)
Normal Saline nasal rinses/spray +/- nasal bulb syringe
Provide parents with concerning S&S (resp distress, lethargy, dehydration – describe) and when to seek medical
OTC cough and cold medicine not good for who?
under 6 years
URTI red flags
Irritable, inconsolable Lethargic Breathing difficulties Unable to tolerate oral fluids Fever persists for 5 days
Bronchiolitis
Definition: Inflammation of the bronchioles.
Air trapping
Major cause of hospitalization in infants < 2 years
Often occurs during the winter (Peak Jan/Feb)
Respiratory Syncytial Virus (RSV) most common causative agent. RSV Prophylaxis avail for high-risk populations.
tx for bronchiolitis
Self limiting disease but severe cases are hospitalized (i.e. Apnea, toxic, need for O2, dehydration, lethargy)
Reliable caregivers – need for close monitoring
Primarily Supportive Tx (fluids, nasal bulb suction, NS gtts)
Inhaled bronchodilators: Cochrane review –
given lack of evidence can not be
recommended for routine tx of bronchiolitis.
May be helpful with viral-induced asthma
patients
Antibiotics only when there is a coexisting
bacterial infection
Croup (Laryngotracheobronchitis)
Etiology: caused by viruses (Parainfluenze, RSV, Adenovirus). May have secondary bacterial infection.
Self limiting upper airway infection that causes diffuse inflammation with exudate & edema of the larynx/subglottic area causing narrowing of the airway
Etiology: caused by viruses (Parainfluenze, RSV, Adenovirus). May have secondary bacterial infection.
red flags of croup
dx?
Flags: cyanosis, head bobbing, drooling, lethargy/toxic-appearing,
Usually a clinical diagnosis based on the barking cough & stridor
Rule out other causes of obstruction –if not sure, then a neck/chest x-ray may be helpful
Usually imaging or labs are not necessary
Radiologic finding: Cone shapednarrowing
ofthesubglotticarea(“SteepleSign”). Absent in 50-60% cases
croup
Home Management:
PO Fluids – prevent dehydration
Exposure to cool moist air
No benefit of Mist tents, or bedside humidifiers
Reliable caregivers, access to urgent/emergent care, follow-up
Emergency Room Intervention:
Oral Dexamethasone, Nebulized Racemic
Epinephrine
bacterial pneumonia s/s
Can be abrupt or follow URI Fever-usually high (>39C), chills Resp Distress common Cough-nonproductive/productive Breath sounds: rhonchi, crackles Chest pain Retractions, nasal flaring Pallor, cyanosis GI-vomiting, diarrhea, abd pain rigors, shaking seen more in k ids
tx bacterial pneumonia
what if atypical pneumonia - mycroplasma?
amox
pen allergy - macrolide - azythro
mycroplasma - start microlide
