1 - Paeds - Resp - Chest infections - Pneumonia Flashcards Preview

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Flashcards in 1 - Paeds - Resp - Chest infections - Pneumonia Deck (16):
1

when does incidence peak?
% of cases with no ID'd pathogen? most common causes in older and younger kids?

in infancy and old age - also high in kids
50% have no id pathogen
younger - viruses more common
older - bacteria more common

2

newborn causes

organisms in mothers genital tract - GBS, Gram -ve enterococci

3

Infants and young kids causes

resp viruses
RSV most common
bact infections include strep pneum or h influenzae
S Aureus is rare but serious case

4

Childern >5 causes

mycoplasma pneumoniae, strep pneumoniae, chlamydia pneumoniae

5

all ages causes

mycobacterium TB should be considered

6

what immunisations are available

conjugate vaccine (prevenar) vs. 13 most common serotypes of Strep pneum responsible for invasive disease. Hib vs H Influenzae type B

7

common presentation -

fever Hx and difficulty breathing - usually preceded by URTI

8

other sx

cough, lethargy, poor feeding, unwell child, localised chest, abdo or neck pain > pleural irritation > bacterial cause

9

O/E -

tachypnoea (best, always measure in febrile kid > 'silent pneumonia), nasal flaring, chest indrawing
end inspiratory coarse crackles over affected area. classical signs of consolidation eg dullness to percussion often absent in infants. O2 sat decreased (admit)

10

Ix - to confirm? which cause can CXR ID? whats useful in younger kids?

CXR to confirm
can only look for strep pneumoniae lobar pneumonia appearance.
NP aspirate to ID viral causes

11

What else may be seen on CXR? what can this progress to? to confirm this?

pleural effusion (blunting of CPA on CXR) - may go to empyema and fibrin strands form > septations > difficult drainage. Use USS to confirm

12

mgmt of pneumonia in kids - indications for admission?

generally mged at home,
indications for admission.... O2 <93% and difficulty breathing, grunting, apnoea, not feeding, unable to manage at home

13

General supportive care given?

O2 for hypoxia, analgesia for pain, IV fluids for dehydration and fluid balance

14

Antibiotics - determined by?
newborns? older infants? >5's

age, severity and CXR appearance
newborn - broad spec AB IV
older infants - oral amox, broader spec
>5 amox or oral macrolide (erythromycin)

15

If empyema develops?

drain
either
1 - surgical decortication
2 - place chest drain with/without fibrinolytic agent in intrapleural space to break down septations

16

prognosis - follow up needed?

virtually all make full recovery
CXR 4-6 weeks after
follow up if lobar collapse, atelectasis or empyema

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