Lecture 7 - Pulmonary Flashcards
Bronchiolitis
Viral etiology: RSV, influenza, parainfluenza, metapneumovirus
Presentation: apnea (especially <4 months of age) copious rhionrrhea cough/wheeze \+/- fever
Dx: does NOT require Xray
specific cause can be confirmed by antigen detection testing or PCR
RSV is MC
Tx: supportive care
- nasal suctioning, hydration, sup O2
- trial of B2 agonist or recemic epi
- nebulized 3% hypertonic saline
Why screen for RSV? avoid unnecessary ABX use
What are the pathogens causing bronchiolitis?
Viral etiology: RSV, influenza, parainfluenza, metapneumovirus
RSV MC cause
What is the clinical presentation of bronchiolitis?
apnea (especially <4 months of age)
copious rhionrrhea
cough/wheeze
+/- fever
How do you dx bronchiolitis?
does NOT require Xray
specific cause can be confirmed by antigen detection testing or PCR
RSV is MC
What is the treatment of bronchiolitis?
supportive care
- nasal suctioning, hydration, sup O2
- trial of B2 agonist or recemic epi
- nebulized 3% hypertonic saline
Why screen for RSV? avoid unnecessary ABX use
Sequelae of bronchiolitis?
obstruction of upper.lower airways can lead to respiratory failure in infants
higher risk in premature and younger infants
can be mitigated with monthly palivizumab (Synagis)
When do pts with bronchiolitis need to be hospitalized?
presents with apnea
unable to maintain oral intake
hypoxemia (<90%)
concern for impending respiratory failure
What is the RSV prophylaxis?
palivizumab (synagis)
IgG monoclonal antibody
administered monthly during RSV season
Recommended:
infants born <29 weeks gestation, younger than 12 months at onset of RSV season
Who gets Palvizumab?
Synagis
RSV prophylaxis
Recommended:
infants born <29 weeks gestation, younger than 12 months at onset of RSV season
Impending Respiratory Failure in Infants can be caused by?
upper or lower airway obstruction
sepsis
hypotonia
How do pts with impending respiratory failure in infants present?
increased accessory muscle use
inability to coordinate feeding
decreased arousability
hypoxemia/hypercarbia
Pertussis clinical presentation
incubation period 7-10 days
stages:
- catarrhal: cough and rhinorrhea (1-2 weeks)
- paroxysmal: paraoxysms, inspiratory whoop, post-tussive emesis (2-8 weeks)
- convalescent: gradual waning of sxs (weeks to months)
fever generally absent
What are the stages of pertussis?
- catarrhal: cough and rhinorrhea (1-2 weeks)
- paroxysmal: paraoxysms, inspiratory whoop, post-tussive emesis (2-8 weeks)
- convalescent: gradual waning of sxs (weeks to months)
How do you dx pertussis?
PCR
Culture
DFA - direct fluorescent antibody)
Serology
Clinically:
-paroxysmal cough, post tussive emesis, whoop
What is the treatment for pertussis?
Macrolides
-azithromycin (5 days)
Alternative: erythromycin (14 days), clarithromycin (7days), TMP-SMX (14 days)
During which phase of pertussis, if treated with a macrolide, will ameliorate the cough?
catarrhal
What are some potential complications of pertussis?
hospitalization apnea PNA seizure death
What/who is the most common source of infection of pertussis?
sibling
followed by mother
What is the first sign of PNA in infants?
apnea
How do neonates with PNA present?
fever or hypoxia only
How do children with PNA present?
fever chills tachypnea cough malaise retractions apprehension
How does viral PNA differ in presentation from bacterial PNA?
viral - cough, wheezing, URI sx
Bacteria - high fever, chills, cough, dyspnea, focal lung findings
Atypical - tachypnea, cough, crackles on auscultation
What is the MC PNA causing pathogen in neonates?
GBS
What is the MC PNA causing pathogen in 1-3 months old?
febrile - RSV
afebrile - chlamydia, mycoplasma, bordetella pertussis
