Wheezing child Flashcards
acute onset: weak cough, wheezing after eating
inability to speak/cry
cyanosis, respiratory distress
vomiting, drooling, blood-streaked saliva
exam: unilateral wheezing, inspiratory stridor, ↓ or unequal BS
no chest rise on ventilation attempt
clutch neck with hands (universal choking sign)
common 6 mo-3yo
foreign body airway obstruction
treatment of foreign body obstruction
ventilation and head-tilt maneuver to open airway
if ventilation unsuccessful (no chest rise): Heimlich maneuver (subdiaphragmatic abdominal thrusts)
if unsuccessful after 1 min, call EMS and continue CPR
bronchoscopy
CXR may show radiopaque object or localized hyperinflation and/or atelectasis
etiology of acute wheezing
acute: asthma, viral bronchiolitis, FBAO
recurrent: bronchomalacia, vascular rings and slings, GERD, bonrchopulmonary dysplasia, CF
most common cause of acute wheezing if younger than 2 yo (peak: 1-3 mo), most common hospitalization if
bronchiolitis
initial (URI): rhinorrhea, nasal congestion, pharyngitis → low grade fever
2-5 days later: worsening rhinorrhea, cough, irritable, dyspnea, wheezing → poor PO intake, dehydration
exam: wheezing, fine crackles, prolonged expiratory phase, ↑ RR, increase WOB (nasal flaring, intercostal retraction, apnea)
other signs: hypo or hyperthermia, otitis media
bronchiolitis
diagnosis of bronchiolitis
presentation, age, time of year, physical exam
CXR only if uncertain or unusual: bronchial wall thickening, tiny nodules, linear opacities, atelectasis, patchy alveolar opacities, lobar consolidation
CBC: Normal
sputum culture if pneumonia or bacterial superinfection suspected
r/o bacterial pneumonia, sepsis, congestive heart failure
hospitalization for RSV if
respiratory distress
treatment of RSV
self-limited, can manage OP
if SpO2
singe best indicator of severity of bronchiolitis is:
low SpO2
good prognosis: good PO intake, > 2mo, SpO2 equal or > 94%
hx of bronchiolitis is risk factor for
developing asthma
most common cause of airway obstruction if 6 mo-6 years
leading cause of hospitalization if
croup
etiology of croup
viral infection causes inflammation of subglottic region of larynx
12 hr-3 days: rhinorrhea, low-grade fever
barking cough
hoarseness
stridor
respiratory distress worse at night, hypoxia in severe cases
confirmatory neck xray: “steeple sign” subglottic narrowing of tracheal lumen
croup
treatment of croup
based on severity of symptoms (Wesley croup score):
LOC
cyanosis
resting stridor
air entry
retractions
mild: single CS dose (↓ laryngeal edema) to prevent hospitalization
mod: epinephrine + single CS to prevent hospitalization
severe (cyanosis, ↓ LOC, severe stridor, severe retractions, toxic): hospitalization with steroids + nebulized epinephrine (adrenergic effect: constrict arterioles → ↑ fluid resorption, B2 effect: bronchial SM relaxation, brochodilation)
emergency: O2 (not humidified like bronchiolitis)
drugs to avoid if have croup
sedatives opiates expectorants bronchodilators antihistamines
