RSV and Bronchiolitis Flashcards
When does respiratory distress occur?
when the bodies metabolic demand for oxygen is not being met due to a failure of oxygenation or ventilation
How does respiratory distress present in children?
Increased WOB
Abnormal breathing pattern
What are some reasons that PEDs rapidly decompensate?
Smaller airways
Increased metabolic demand
Decreased respiratory reserve
Inadequate compensatory mechanisms
What is the most common cause of cardiac arrest in children?
Respiratory arrest
What is a decrease in respiratory rate in a child in respiratory distress a sign of?
Impending respiratory failure
What are the components of the pediatric assessment triangle?
Appearance
WOB
Circulation
What are the components of how a child appears?
Tone
interactiveness
consolability
speech/cry
What are the components of work of breathing?
Abnormal breath sounds
Abnormal positioning
Retractions
Nasal flaring
What are the components of circulation to the skin?
Pallor
Mottling
Cyanosis
What is considered a fever in PEDs?
100.4 F or 38 C
What are fevers typically a response to?
viral infection
When does the immune system mature?
2-3 months
What cultures would you get in a PED that has a fever?
Respiratory
Urine
Spinal Fluid
What is the main way to protect newbornes from viral infections?
TDAP vaccine
wash hands
dont kiss the baby
What is the virus responsible for whooping cough?
Bordetella pertussis
How is whooping cough transmitted?
droplets
What can whooping cough cause in infants?
apnea
minimal cough
seizures
PNA
respiratory failure
cardiac failure
death
When do RSV infections primarily occur?
fall and winter
What is the leading cause of lower respiratory infections in young children?
RSV
how is RSV transmitted?
Cough and direct physical contact from infected individuals or objects
Describe RSVs contagious level
highly contagious
Why is RSV so contagious?
Can live on surfaces for 2-8 hours
Infected individuals can be contagious for up to 3 weeks
What are risk factors associated with RSV?
childcare attendance
older siblings in school
exposure to environmental pollutants
What factors are associated with more severe RSV infections?
Prematurity
Younger than 3 months
preexisting chronic lung disease
congenital heart disease
congenital immunodeficiency
family history of asthma
Describe the pathophysiology of RSV
Begins in upper respiratory tract
Progresses rapidly over 1-2 days to diffuse small airway disease
Leads to edema of small airway and increased mucus production that
What does the increased mucus production associated with RSV cause?
partial or complete obstruction of the airway leading to air trapping or alveolar collapse and PNA
How can RSV be diagnosed?
Situationally dependent, if patient is comfortable and stable, no test needed
CBC
Serum electrolytes
urine analysis
ABGS
sputum culture
antigen testing
PCR assay
chest radiograph
How does RSV present?
Cold like symptoms
Tachypnea, chest wall retractions
cyanosis
ear infection
dehydration
how can you test for dehydration?
Dry diapers
dry mucus membranes
What medication can be given for RSV?
Ribavirin (virazole)
What is the leading cause of pediatric hospitalizations in the US?
Bronchiolitis
What viral pathogens can cause bronchiolitis?
RSV, flu, parainfluenza etc
Describe bronchiolitis pathophysiology
Infection of upper respiratory tract
Virus spreads from upper respiratory tract to the medium and small bronchi and bronchioles
Necrosis of the respiratory epithelium occurs and triggers an inflammatory response
Inflammation causes bronchiole obstruction
What can the obstruction caused by inflammation and mucus in bronchiolitis cause?
Airtrapping
alveolar hyperinflation
what is the most significant consequence of bronchiolitis?
Hypoxemia
how is bronchiolitis diagnosed?
differential clinical diagnosis
Nasal swab to confirm viral infection
Thorough examination of patient and surrounding situation
What is not recommended to diagnose bronchiolitis?
CXRs
How does bronchiolitis clinically present?
rapid onset
lack of appetite
low grade fever
cough, dyspnea, wheezing, rhinorrhea
signs of respiratory distress
paradoxical breathing
periods of apnea
What are none respiratory manifestations of bronchiolitis?
ititis media
myocarditis
superventricular and ventricular dysrhythmias
How is bronchiolitis treated?
Supportive care
Supplemental oxygen
secretion clearance
chest PR
bronchodilators
corticosteroids
What is the leading cause of death in children worldwide?
Flu
How is the flu transmitted?
Droplet
Describe the pathophysiology of the flu
- virus in host cells causes cellular dysfunction and degeneration resulting in inflammatory mediator release
- Targets epithelial lining of respiratory tract
How is flu diagnosed?
Based on clinical symptoms of headache, fever, chills, muscle aches, weakness, fatigue, nasal congestion, sore throat and cough
Can also be diagnosed via viral cultures, and molecular tests
What is the gold standard of flu diagnosis?
Viral cultures
How is the flu best managed or treated?
via prevention from vaccination
