W2 - Acute Respiratory Presentations in Kids Flashcards
what is the most common cause of kids coming into hospital
respiratory issues and Respiratory distress
what are the 4 most common causes of breathlessness in kids
- asthma
- croup
- bronchiolitis
- pneumonia
what is acral cyanosis
when only peripheries are blue
very common in new babies and is completely normal
what does stridor sound like
youtube
(harsh sound from upper airways inspiratory +/- expiratory “seal noise”)
what does croup sound like
youtube
what does grunting sound like
youtube
- most often in infants with significant respiratory distress e.g bronchiolitis
- due to glottis closure in expiration to h end expiratory pressure to keep alveoli open
what is recession in breathing
indrawing of muscles of rib cage (soft chest wall is pulled in with breathing)
what are some respiratory red flags
tachypnoea - as adjusted for age
chest indrawing
trachea tug
head bobbing
hypoxia
why can auscultation of the chest in a child sometimes be misleading
small chest
therefore sounds can be transmitted and heard all over.
A small infection takes up a more significant part of their chest - more serious
most common cause of bronchilolitits
RSV
what can you see on the x ray
Parenchymal infiltrates
Pulmonary vascular markings
Cardiac size
Hyper aereation
Air leaks
Position of diaphragm
what causes extra-thorasic congenital causes of respiratory insufficiency
Laryngomalacia
Tracheomalacia
Subglottic stenosis
Subglottic web
Craniofacial anomalies
what causes extra-thorasic acquired causes of respiratory insufficiency
Infections (croup, bacterial tracheitis)
Foreign body aspiration
Trauma
what causes intrathorasic airway and lung causes of respiratory insufficiency
Bronchiolitis
Pneumonia
Asthma
Aspiration
Vascular rings
Tracheomalacia/Bronchomalacia
Cardiovascular disease
Pulmonary oedema
Pulmonary embolus
what causes respiratory pump causes of respiratory insufficiency
Spinal muscular atrophy
Duchenne muscular dystrophy
Diaphragmatic hernia
Guillain-Barre
Myasthenia Gravis
Spinal cord trauma
what causes central control causes of respiratory insufficiency
Meningitis and other infections
Central sleep apnoea
Congenital central hypoventilation syndrome
Drug overdose
Traumatic brain injury
what causes croup
upper airway viral infection
how does a upper viral illness cause croup
Upper airway viral infection
- inflammation - airway obstruction
what can be associated with croup
- inspiratory + /- expiratory stridor
- intercostal/subcostal/sternal recession & tracheal tug
what is the progression signs to resp failure in croup
stridor softening
(tiring due to effort of breathing through obstruction)
how do you treat croup
- PO dexamethasone/ prednisolone OR NEB budesonide
- IF SEVERE - nebulised 5ml 1:1000 adrenaline
who tends to get bronchiolitis
infants in winter (September-April)
what is the aetiology of bronchiolitis due to Viral infection
Viral infection of lower airways - inflammation - secretions
what is the management of bronchiolitis
SUPPORTIVE
- NGT feeds OR IV fluids
- oxygen
what medication can be given to infants to prevent RSV in high risk babies
Palivizumab
who would you give Palivizumab to?
premature
heart or lung conditions - CF, congenital heart defects etc
what are the 3 main viruses that cause pneumonia
- Streptoccocus pneumoniae
-Haemophilus Influenza type b (HiB) - Mycoplasma pneumoniae (Atypical) - 20%
when do you suspect pneumonia
Cough/difficulty of breathing and Tachypnea
what other extrapulmonary symptoms can you get in pneumonia
Diarrhoea, vomiting, myalgia, abdominal pain
when would you do an xray for diagnosis of pneumonia
- respiratory distress,
- Fever ≥ 39◦C
- Rapid deterioration or not response to treatment
- Complication - pleural effusion
what is the managment for pneumonia
- Abx
PO amoxicillin
Macrolide added in severe disease or mycoplasma/chlamydia pneumonia suspected
what is the criteria for admission
- SpO2 <92% in air 2. Apnoea or grunting 3. Significant respiratory distress 4. Poor feeding 5. Concerns regarding supervision
In what cases would management of pneumonia be different
- hospital acquired
- CF
- cerebral palsy
what is the most common respiratory condition in kids
asthma
REVISE ASTHMA
what are common riggers of asthma
animal fur
dust
pollen
cigarettes
perfume
weather - cold
exercise
viral infection
how do you treat asthma
Beta agonist - salbutamol
steroid inhaler
when do you prescribe supplementary oxygen
all kids with O2 sats below 92%
when would this thershold be lower
Severe heart failure, Severe sepsis, asthma or brain injury (target o2 sats ≥94%)
what are the 4 methods of giving oxygen in kids
- nasal cannula
- face mask reservoir
- high flow nasal cannula
- MV
