LRTI Flashcards by Eilidh Seaton

How do you manage LRTI

Make Dx
Assess patient - oxygenation, hydration, nutrition
Decide whether to treat

How well did you know this?

Not at all

Perfectly

What is LRTI

>48 hours 
Fever >38.5
SOB
Cough
Grunting 
Reduced or bronchial breath sounds

How well did you know this?

Not at all

Perfectly

What makes bacterial cause of LRTI unlikely

Wheeze

How well did you know this?

Not at all

Perfectly

What are common agents in LRTI

H influenza 
Pneumococcus
Mycoplasma
Chlamydia 
S.Aureus

How well did you know this?

Not at all

Perfectly

When do you call it pneumonia

Signs are focal
Crepitations
Consolidation on CXR in adults 
High fever / cough  / SOB etc
Otherwise = LRTI but can call it this as pneumonia causes anxiety

How well did you know this?

Not at all

Perfectly

What is 1st line treatment in acute LRTI and when do you treat

Amoxicillin 
Macrolide 2nd line
Look for scarlet fever rash 
IV only if vomiting  
Treat if oxygenation, nutrition and hydration is okay

How well did you know this?

Not at all

Perfectly

How do you diagnose LRTI

What is not routine

HISTORY
CXR and inflammatory markers NOT routine
Only do CXR / bloods if suspect empyema / sepsis

How well did you know this?

Not at all

Perfectly

What are signs of respiratory distress

Increased RR >70
Increased HR >160 
Grunting
Nasal flaring
Recession - sternal, intercostal, subcostal
Use of accessory muscles - SCM, abdominal and intercostal 
Cyanosis
Sweating
Tracheal tug
Head bobing
Wheeze
Stridor 
As get exhausted - go into type 2 resp failure and develop cyanosis

How well did you know this?

Not at all

Perfectly

What is bronchitis

Self limiting infection of bronchi

How well did you know this?

Not at all

Perfectly

What age group is bronchitis common in

2-3 years

How well did you know this?

Not at all

Perfectly

What does bronchitis present with

Loose rattly cough - can continue for week
Post vomit / glut
May have cold like symptoms, wheeze, sore throat
Chest free of creps / crackles

How well did you know this?

Not at all

Perfectly

What causes bronchitis

RSV - common in winter
Adenovirus
Switch of mucociliary clearance so repeated infection
Bacteria can also cause on top

How well did you know this?

Not at all

Perfectly

How do you Rx bronchitis

Supportive

Full septic screen / LP if <3 months + fever

How well did you know this?

Not at all

Perfectly

What are red flag symptoms (suggest bronchiectasis)

<6 months or >5
Worry in babies especially <1 months as should have mother IgG -full septic screen / LP if fever
FTT
Disrupt QOL
SOB at rest
Co-morbidities

How well did you know this?

Not at all

Perfectly

What is bronchiolitis

LRTI of infants common in <1 year
Most common 3-9 months as <3 months should be protected
Can occur up to 2 years particularly if pre-mature / chronic resp disease
33% get bronchiolitis
3% admitted

How well did you know this?

Not at all

Perfectly

What causes bronchiolitis

RSV most common (RNA) virus
Paraflu III
Often FH of URTI

How well did you know this?

Not at all

Perfectly

When is bronchiolitis common

Winter months

Never recurrent like viral wheeze

How well did you know this?

Not at all

Perfectly

What are the symptoms of bronchiolitis

Coryza prodrome - discharge / snuffly
Persistent cough - can last week 
Signs of resp distress
Dyspnoea 
Tachypnoea
Chest recession
Wheeze/ crackles in chest due to small airways filled with mucous 
\+- fever (30%)
Poor feeding due to SOB 
Increased respiratory effort - refer to 2 care

How well did you know this?

Not at all

Perfectly

How may an infant <6 week present

Apnoea only

How well did you know this?

Not at all

Perfectly

When do you admit to 2 care

<3 months 
Pre-mature /
Pre-existing lung disease 
Apnoea
Persistent low sats
Inadequate oral intake
Dehydration 
Lethargy
Persistent resp distress
CYanosis 
Social issues

How well did you know this?

Not at all

Perfectly

Who are at risk of more severe

Chronic lung - CF
Congenital heart
<3 months
Premature
Bronchpulmonary dysplasia 
Immunedeficient
Neuromuscular - may not see respiratory signs 
Parenteral smoke

What is the typical history of bronchiolitis

Getting worse 5 days
Worse 3-5
Stabilise and recovery over 2 weeks
Think is oxygen, hydration, nutrition okay?

How do you Dx bronchiolitis

NPA
02 sats show severity
No routine blood / gas / CXR

When would you do blood / gas / CXR / sputum culture

ABG if looks very unwell to see C02 levels / or if on ventilation
If focal signs to exclude pneumonia / pneumothorax

How do you treat bronchiolitis

``` Max observation, minimal intervention If sats >92% and feeding >50% = safety net Admit Isolation and PPE 02 if sats <92% (humidified) Fluids May need NG tube if not feeding Rarely CPAP Intubation if resp failure Consider suction if significant secretion ``` Bronchodilators do not work as b2 receptors immature in <2

If you send home what do you safety net with

If increased respiratory effort Decreased fluid intake Exhausted Dry nappy

When do you discharge

Adequate oral intak | Sats okay for 4 hours

When would you consider pneumonia

Bronchiolitis If high fever Persistent focal signs - crackles, decreased breath sound, bronchial breathing Older child

What is important to remember with pneumonia

Look for rash of scarlet fever

When would you consider viral induced wheeze

``` Persistent wheeze No crackles Recurrent episodic wheeze Don't fit LRTI Prev HX ```

What causes viral induced wheeze

RSV = common Passiv smoke worsens Rare in

How do you treat viral induced wheeze

``` Mild = none SABA (10 puffs MDI) or anti-cholinergic Inhaled steroid - bexamethasone / LTRA Oral pred if admitted Send home with SABA and reduce amount ```

What do you do for recurrent viral induced wheeze

Give a preventer - ICS / LTRA

Is it asthma

Could be Rare in <5 Have to wait and see as no test

Who gets RSV monoclonal Ab

Immunocompromised Repet bronchiolitis Premature Lung or heart abnormality

What causes Whooping cough

Bordetella pertussis - gram -ve Inc 10-14 days Routinely immunised - no life long protection Particuly vulnerable as newborn so pregnant women immunised

What are the symptoms of whooping cough

Whooping cough - inspiratory whoop episodes during coughing fit Followed by fainting / vomit after Mild respiratory prodrome 2-3 days prior Central cyanosis Apnoea - can present with this rather than cough Petechia from cough / subconjunctival haemorrhage Marked lymphocytosis Chest clear

What are complications of whooping cough

``` Pneumothorax Bronchiectasis Anoxic seizure Pneumonia Encepahlopathy - seizure ```

How do you Dx whooping cough

Nasal swab - culture / PCR if symptoms <2 weeks | Serology of blood if >2

How do you Rx whooping cough

Oral macrolide if within 21 days for 3 weeks Ax prophylaxis to household contacts Exclude from school 48 hours after Ax or if <21 days from symptom onset Vaccine to newborn and pregnant women

When do you admit

<6 months Apnoea Complications Resp difficulty

Do you report to public health

Yes

See respiratory

How does chronic lung disease present

Hyper-inflated lung Surgical emphysema Pectus carnatum (out) Pectus excavatum (in)

If patients presenting with recurrent LRTI what should you think

Underlying lung condition e.g. CF | Underlying immune

What should you asses for

``` Reflux Aspiration Neurological disease Heart disease Asthma CF Primary ciliary diskinesia Immune deficiency ```

What tests

``` FBC for WBC CXR for structural Serum Ig to look for low levels Sweat test HIV ```

Causes of clubbing in children

``` CF Bronchiectasis Cyanotic heart disease IE TB IBD Liver cirrhosis ```

What is primary ciliary dyskinesia

AR condition Affects cilia of tracts Also known as Kartamenger

What is the triad

Sinusitis Bronchiectasis - build up of mucous, chronic infection Infertiltiy - affects epithelium of Fallopian tube Situs inverts - all organs on different side not just the heart

How do you Dx

FH Examination CXR to show situs invertus Sample of ciliated epithelium for analysis

How do you Rx

Similar to CF and bronchiectasis Physio High calorie diet Ax