stridor in kids + bronchiolitis Flashcards
croup
URTI
characterised by stridor which is caused by a combo of laryngeal oedema + secretions
croup causative organism + age incidence
parainfluenza viruses
peak incidence - 6months-3yrs
more common n autumn
croup presentation
cough
- barking, seal-like
- worse at night
Stridor
fever
coryzal sx
increased work of breathing
key point when examining suspected croup or epiglottitis
DO NOT examine throat can precipitate airway obstruction
croup severity
mild - occasional barking cough, happy, eating+drinking
mod - audible stridor at rest, distractable/interested in surroundings
severe - frequent cough, marked sternal retractions, tachycardia, distress
NICE guidance for admitting child with croup
- mod or severe
- <3months
- know upper airway abnormalities (laryngomalacia, downs)
- uncertainty about diagnosis
croup investigations
clinical
CXR - subglottic narrowing steeple sign
management of croup
single dose of oral dexamethasone
-> all kids regardless of severity
emergency treatment in severe croup
high flow oxygen
nebulised adrenaline
causative organisim in epiglottitis
haemophilus influenzae B
- kids are immunised, raise suspicious in unvaccinated
acute epiglottitis presentation
RAPID onset
high temp, generally unwell
stridor
drooling
Tripod position
can occur in adults too
diagnosis of acute epiglottitis
direct visusalisation (only by senior/airway trained staff)
- do NOT examine throat
xray - thumb sign (swelling of epiglotis
management of acute epiglottitis
immediate senior involvement
- endotracheal intubation may be necessary
oxygen
IV antibiotics
inhaled foreign body
can go unnoticed
features -
- cough
- stridor
- dyspnoea
where are inhaled foreign bodies most likely to be found
right main bronchus
- wider shorter + more vertical
laryngomalacia
congenital abnormality of larynx
infants typically present 4 weeks of age with stridor
self-limiting, resolves as cartilage matures
bronchiolitis causative organism
Respiratory syncytial virus (RSV) in 80%
others = mycoplasma, adenoviruses
commonest cause of LRTI in <1yrs
bronchiolitis
- peak incidence 3-6months
maternal IgG provides protection to newborns against RSV
conditions that are bad news in bronchiolitis
bronchopulmonary dysplasia (premature)
congenital heart disease
cystic fibrosis
bronchiolitis presentation
coryzal sx precede;
- dry cough
- increasing breathlessness
- wheezing, fine inspiratory crackles
feeding difficulties assoc with increasing dyspnoea -> usually reason for admission
NICE guidance for immediate bronchiolitis referral (999)
apnoea
kids looks v unwell to professional
severe resp distress - grunting, marked chest recession or resp rate >70
central cyanosis
o2 sats <92%
consider referral if
- RR >60
- difficulty feeding
- clinical dehydration
bronchiolitis investigation
immunofluorescence of nasopharyngeal secretions may show RSV
management of bronchiolitis
largely supportive
- humidified oxygen given via head box if sats <92%
- nasogastric feeding if not feeding/drink by mouth
