The infant or child with breathing difficulties Flashcards
Most common cause of wheezy child-coryza, breathless, cough (3)
URTI
Asthma
Bronchiolitis
Causes of ‘chestiness’ (10) and important features
Bronchiolitis Asthma Pneumonia Heart failure Viral induced wheeze Foreign body Whooping cough Croup TB
Traumatic->pneumothorax, hemothorax DKA, acidosis, deH, anxiety Peritonsillar abscess Spontaneous pneumothorax of teenager Cough without breathlessness
Causes of cough without breathlessness (5)
GORD Post nasal drip Tracheoesophageal fistula Passive smoking Cystic fibrosis
History
Evidence of infection- fever, poor feeding
Previous history of wheezing- recurrent asthma
Atopic- eczema, hay fever
Known history of disease which may +risk of developing bronchiolitis- congenital heart disease, prematurity
Relevant family history- TB, CF, CHD
Examination
Signs of respiratory distress->grunting, intercostal recession, nasal flaring
Are there additional noises->whooping, stridor, barking cough
Signs of chronic respiratory conditions->clubbing, chest wall deformities
Cyanosis?
Pyrexial?
Evidence of congenital heart disease?
Evidence of consolidation
Can the child talk in full sentences?
Is the PEFR normal?
Investigations and importance
CXR->consolidation (lobar/diffuse), collapse, heart failure, hyperinflation
FBC->leukocytosis (penumonia), lymphocytosis (TB)
Nasopharyngeal swab->viral immunoflurescence
Sputum->acid fast bacilli
Perinasal swab->Bordetella pertussis
Viral titres->atypical pneumonia (Mycoplasma)
Blood cultures->S pneumonia if bacterial pneumonia
Mantoux test->TB
Bronchoscopy->Removal of foreign bodies
Viral causes of pneumonia
RSV Parainfluenza Influenza Adenovirus Coxsackie
Bacterial causes of pneumonia
S. Pneumonia
Haemophilus influenza
S. Aureus
Mycoplasma pneumonia
GBS in newborn
Which infectious agents more common in those with underlying respiratory disease
Pseudomonas
Staphylococcus aureus
Predisposing factors in penumonia
Congenital anomaly of respiratory tract Aspiration Foreign body Immunosuppressioin CF
First line treatment for lobar pneumonia
Penicillin
Complications of pneumonia
Empyema
Septicemia
Pleural effusion
Abscess
Cause of bronchiolitis
Most commonly RSV
Parainfluenza
Adnovirus
Clinical features of bronchiolitis
Coryza
Cough
Respiratory distress
Wheeze
Examination findings in bronchiolitis
Widespread wheeze
Fine crackles
Hyperinflation
Patchy collapse/consolidation on CXR
How is RSV diagnosed
Nasopharyngeal aspirate
Indications for hospitalisation in bronchiolitis
++Respiratory distress
Need for oxygen
Poor feeding
Apnoea
How long does RSV usually last
7-10 days
Mortality in RSV
1-2%
Prophylaxis for those at high risk of RSV in winter months
Pavilizumab
Monoclonal antibody against RSV
How if bordatella pertussis cultured
Peri-nasal swab
How long can the paroxysms of cough last in whooping cough
Months
100 day cough
Age typically affected by croup, causative agent, signs of severe
6 months to three years
Parainfluenza
+work of breathing, cyanosis and restlessness
How does epiglottitis present
Sepsis
Inability to swallow or talk
Lean forward
Drool saliva
Confirmation of diagnosis
Laryngoscopy- cheer red swollen epiglottitis
Causes of apnea
Bronchiolitis Pertussis Sepsis Meningitis Fits
When should apnea be considered
Floppy and cyanosis
Red flags
Choking
Apnea
Status asthmaticus
What is status asthmaticus
When does not respond to three + medications, requiring repeated nebulisers.
Differential of cyanosis in a newborn
Cyanotic heart disease -TGA -TOF Pulmonary atresia RDS Transient tachypnea of the newborn PPHN Pneumothorax Aspiration pneumonia Pulmonary edema Congenital diaphragmatic hernia Upper airway obstruction Polycythemia Asphyxia met-Hb Hypoglycemia Neonatal sepsis
If cyanosis does not improve when given oxygen, likely explanation
Congenital heart disease with left to right shunt
How does cardiac failure present in neonates and infants
Symptoms - sweating, poor feeding due to breathlessness (ultimately poor weight gain)
Signs - tachycardia, tachypnoea, hepatomegaly
Note: basal crepitations and dependent oedema are very late signs in childhood.
Common differential for cough
Pneumonia Asthma URTI Bronchiolitis Croup Whooping cough Inhaled foreign body
Common differential for wheeze
Bronchiolitis
Asthma
Heart failure
Inhaled foreign body
Common differential of stridor
Acute: Croup anaphylaxis inhaled foreign body epiglottitis
Chronic:
Laryngomalacia
laryngeal anomalies
When to suspect bronchiectasis symptoms and signs
Indigenous child Symptoms: chronic cough excessive sputum production clubbing suboptimal weight gain
Signs:
chest deformity
persistent crepitations and wheeze on
auscultation.
Differences in respiratory system in pediatrics
Up to 6/12 obligate nasal breathers Smaller Trachea and rib cage more cartilaginous Larynx at cervical spine 2-3, more difficult to view with laryngoscope Cricoid ring narrowest Short trachea->ETT can pop out
Sinus anatomy
- maxillary->first to develop, 3 & 7-8 years
- ethmoid
- Frontal
- Sphenoid
