Week 11 Respiratory Flashcards
bronchitis patho
- edema and inflamed mucous membranes of the trachea and bronchioles
- release of pro-inflammatory mediators and increase in secretions
acute bronchitis clinical manifrestions & majority of etiology is?
- cough lasting 5+ days
- nasal congestion, h/a
- Dyspnea→ inflammation in the airways.
- Purulent or non-purulent sputum
- URI before bronchitis
- Low grade fever at onset
- chest wall pain
- VS normal, no consolidation
- wheezes, rhonchi
majority viral!!
Indications for chest xray for acute bronchitis
- NOT needed for mild or classic cases
- get xray if (sx’s of pneumonia):
- Dyspnea, bloody/rusty sputum
- HR > 100
- RR > 24
- oral temp > 100ºF (37.8ºC)
- Focal consolidation, egophony, or fremitus
- If >75 yrs, have subtle sx’s of pneumonia and might not have fever or elevated HR
bronchitis management
- Education
- no antibiotics - mostly viral infection
- Smoking cessation
- Supportive care
- Rest, fluids, hydration, stream inhalation • Medications
- Avoid OTC antitussives and antihistamines in ages < 4 yrs old
- honey > 1 yrs
- Improve in 2-3 weeks
influenza sx’s in adults vs children
- both have: fever, myalgia, headache, nausea
- adults: coryza, cough, eye burning, tearing
- children: rhinitis, conjunctivitis, HIGHER fever, lymphadenopathy
- normal lung exam
High-Risk Groups for flu-related complications, therefore, need flu chemoprophylaxis with antiviral medication
- children < 5 yrs old, esp < 2 yrs old
- immunodeficiency or chronic medical conditions (COPD, CVD, DM, renal/neuro/hem disorders)
- < 19 yrs on chronic aspirin therapy
- _>_65+ yrs
- pregnant women + 2 wks post partum
- African Indians
- alaskan natives
- lives in nursing home or chronic care facilities
what are the chemoprophylaxis meds (neuraminidase inhibitor) should be considered for high risk pts who have been exposed to someone with flu w/in last 48 hrs
- oseltamivir (Tamiflu)
- > 3 months yrs
- zanamivir (Relenza)
- > 5 years yrs
- Taken daily for the duration of exposure = shortens duration by 12-24 hrs
- not effective if taken after 48 hrs
most common typical pathogen of pneumonia
Streptococcus pneumoniae
- all age groups (90% in children)
most common atypical pathogens of pneumonia
mycoplasma and chlamydia pneumonia
- NO consolidation
- school age and adolescents
exam findings of pneumonia
- Tachypnea**
- Tachycardia
- Consolidation**
- Decreased O2 saturation
- Crackles, rales, bronchial, asymmetric breath sounds
- Dullness to percussion, incr tactile fremitus
- ego phony, bronchophony
- whisper pectoriloquy
On chest xray for pneumonia, how to differentiate b/t viral and bacteria?
**might be normal the first 24 hrs
Typical pneumonia: Lobar consolidation
bacterial: lobular consolidation, cavitation, large pleural effusion
Atypical/viral pneumonia: Bilateral, diffuse infiltrates, NO CONSOLIDATION
what is the CURB - 65 criteria?
Assesses the severity of pneumonia:
- Confusion
- Urea/BUN > 20
- RR _>_30
- SBP < 90 OR DBP < 60
- > 65 yrs
1 pt each. severity; send inpatient or outpt
- 0-1: outpatient
- 2: short inpatient or closely monitored supervised outpatient
- 3+: inpatient admission, consider ICU admin
if chest x ray is negative for pneumonia
- can still treat for PNA if clinical presentations is suggestive!!
- may not show up for the first 24 hrs
- if have strong suspicion, treat!
initial treatment for outpatients with CAP
- no comorbidites → Amoxicillin, Doxycycline or macrolide (if local pneumococcal resistance < 25%)
- yes comorbidities → amoxicillin/clavulanate or cephalosporin AND macrolide/doxy
- OR just fluoroquinolone
complications of pneumonia
- Pleural effusion
- consider if worsening after 3 days of antibiotics or worsening dyspnea or cough
- Empyema - collection of pus in pleural space
- need to be drained
- bacteremia
- sepsis
pneumonia prevention
- PCV13 if > 65 yrs, then 1 yr later get PPSV 23
- if got PPSV23 at > 65yrs, then 1 yr later get PCV13
- if got 23, have to wait 5 yrs for the next 23
pneumonia sx’s in pediatrics
- **tachypnea**
- Respiratory distress
- nasal flaring, retractions, rales
- *Signs of consolidation
- Lower lobe pneumonia
- Abd pain, vomit
- Poor feeding, irrit, letharagy
- Viral pneumonia
- More common age 1 month to 5 yrs
- Gradual onset of fever, cough, nasal congestion
- More common age 1 month to 5 yrs
evaluating pneumonia in peds
- Ask about immunizations, maternal health, and birth complications in neonates
- NO chest xray
- Imaging and labs if mild → outpatient
- Blood cultures if moderate - severe
- Viral culture for flu considered if flu season
- sputum culture if have sputum
- chest xray if dx is unclear in infants/young
management of pneumonia in peds
- Hospitalization
- < 3 months: fever, poor intake, pulmonary conditions
- > 3 months: respiratory distress, poor feeding, <90% O2, toxic appearing, doesn’t respond to antibiotics
- everyone: issues at home
- Outpatient treatment
-
No antibiotic treatment if:
- < 4 yrs old with mild symptoms
- flu and no evidence of bacterial pneumonia
- if not improving in few days → consider chest x ray
- < 5 yrs → Amoxicillin 90 mg
- > 5 yrs → Azithromycin
- Prevention
- Immunizations / flu shots / pneumococcal / pertussis
-
No antibiotic treatment if:
indications for hospitalization in peds for pneumonia
- Moderate - severe pneumonia:
- respiratory distress-retractions tachypnea, hypoxemia
- O2 sat < 90%
- altered mental status
- Suspicion of MRSA
- Underlying cardiopulmonary conditions, metabolic disorders, neurologic disorders or developmental delay
- Infants less than 4 to 6 months old
risk factors for primary pneumothorax
- spontaneous rupture of pulmonary or sub pleural bleb in pleural space
- Age 20-30, male, smoking, tall stature, thin body habitus, underlying lung disease
secondary pneumothorax
- Lung disease
- Connective tissue disease
- lung cancer
pneumothorax symptoms/on exam
- May be asymptomatic
- Sudden
- Chest pain
- Unilateral/Sharp/Pleuritic
- Dyspnea, tachycardia, diaphoresis
- Tracheal deviation
- cyanosis
- Hyper resonnance to percussion
- decrease lung expansion
pneumothorax diagnostics
- Chest xray of PA and lateral during inspiration but only 50% sensitive
- Visceral pleural line outlining edge of lung, absence of lung markings
- CT gold standard