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Paediatric Upper Airway Issues Flashcards

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1
Q

What are some of the symptoms of upper airway obstruction?

A 
Coughing
Drooling
Difficulty Breathing
Gagging
Inspiratory Stridor
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2
Q

Why might stridor be considered a good sign after aspirating a foreign object?

A

Stridor indicates that there is a partial obstruction creating the turbulent flow and audible sound

If there is a complete obstruction there is no ventilation and no breath sounds may be audible

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3
Q

What is the BLS approach for a choking patient?

A

5 Back Slaps
5 Abdominal thrusts

Note- if older ask for two big cough before starting back slaps.

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4
Q

What investigations may be done in a stable child thought to have aspirated something?

A

CXR or Neck Radiograph to locate the object

Laryngoscopy/Bronchoscopy can both visualise and remove the object

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5
Q

What symptoms might be experienced if a foreign object is aspirated into the nasal cavity?

A

Unilateral foul smelling rhinorrhea
Difficulty breathing
Epistaxis
Obstructed air outflow from nose

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6
Q

What is laryngomalacia?

A

Congenital abnormality of the laryngeal cartilage, shortened aryepiglottic folds pull the epiglottis causing airway obstruction. Most common cause of stridor in newborns.

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7
Q

How do most cases of laryngomalacia correct?

A

Many children grow out of it with age

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8
Q

Why is it important to monitor weight and feeding in children with laryngomalacia?

A

Difficulty breathing leads to issues with feeding and so nutrition may be poor.

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9
Q

Why might laryngomalacia lead to or worsen reflux?

A

Negative pressure is created due to obstruction which can draw up stomach acid causing reflux. This causes irritation and swelling which can worsen the laryngomalacia.

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10
Q

How is laryngomalacia diagnosed?

A

Laryngoscopy or bronchoscopy

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11
Q

How can you divide the causes of rhinitis?

A

Infectious and non-infectious

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12
Q

What are some causes of non-infectious rhinitis?

A

Allergic Rhinitis- Pollen, Dust, Dander
Irritant- Tobacco smoke, Cold or dry air
Exercise

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13
Q

What are some of the symptoms of rhinitis?

A

Nasal congestion
Rhinorrhoea
Sneezing
Sniffling

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14
Q

What treatments might be used for non-infection rhinitis?

A 
Avoid the trigger
Intranasal Antihistamines
Intranasal Steroids
Nasal Douching
Oral Antihistamines
Oral Steroids if severe atopic crisis
Ipratropium bromide (antimuscarinic may be used to reduce nasal secretions)
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15
Q

Are the majority of infectious rhinitis cases due to viral or bacterial infections?

A

Viral

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16
Q

What are the common viral causes of infectious rhinitis?

A 
Rhinovirus
Influenza virus
RSV (Respiratory Syncytial Virus)
Parainfluenza Virus
Adenovirus
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17
Q

What are the common bacterial causes of infectious rhinitis?

A

Strep pneumoniae
Haemophilus Influenzae
Moraxella catarrhalis

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18
Q

What can a fungal cause of rhinitis be an indicator of?

A

Immunocompromised child- aspergillus could be the fungal cause

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19
Q

What are the common viral causes of pharyngitis?

A

Rhinovirus
Coronavirus

Infection may begin as rhinitis and then travel to cause infection of the pharynx

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20
Q

What is a common bacterial causes of pharyngitis?

A

Group A Strep

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21
Q

What criteria should be used to differentiate between a viral and a bacterial cause of pharyngitis/tonsillitis?

A

CENTOR Criteria

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22
Q

What are the CENTOR criteria?

Study These Flashcards
A

C- Cough Absent +1
Exudate Visibile +1
Nodes- Tender Cervical Lymphadenopathy +1
Temperature >38 + 1

23
Q

What CENTOR score should an antibiotic prescription be written for?

Study These Flashcards
A

Scores of 3 or More

A score of 0, 1 or 2 should not be offered an antibiotic prescription as the cause is likely to be viral

24
Q

What advice should be given with a back-up antibiotic prescription?

Study These Flashcards
A

Antibiotic is not needed immediately
Use prescription of no improvement in 3 to 5 days or if symptoms worsen
Seek medical help immediately if symptoms worsen rapidly or the person becomes very unwell

25
How do the symptoms of pharyngitis differ between bacterial and viral causes?
Cough is more likely to be present in viral causes Other cold like symptoms are more likely to be present in a viral cause including- rhinorrhoea, nasal congestion Bacterial causes are associated with fever Cervical lymphadenopathy is more likely to be tender in bacteria causes Exudate is more likely to be present if there is a bacterial cause
26
What should be used as the first line antibiotic for suspected bacterial causes of sore throat?
Phenoxymethylpenicillin (Penicillin V)
27
What should be used as the antibiotic choice for patients who are allergic to penicillin for suspected bacterial causes of sore throat?
Clarithromycin | Erythromycin
28
Where can abscesses form following bacterial infection of the pharynx?
``` Peritonsillar space (Over 10 years) Retropharyngeal space (Under 10 years) ```
29
What are some symptoms of a pharyngeal abscess formation?
High fever Drooling Dysphagia Odynophagia Trismus- difficulty opening mouth for peritonsillar Torticollis- stiff neck for retropharyngeal abscess Unilateral swelling with uvula deviation may be visible on examination Hot potato voice- muffled voice with distorted vowels
30
What are some of the symptoms of a retropharyngeal abscess?
``` High fever Neck stiffness- torticollis Dysphagia Stridor Malaise Tender cervical lymph nodes ``` Difficult to see of physical examination but concerns may be raised when there is neck stiffness and feature of infection. It is a complication of untreated bacterial pharyngitis.
31
Why can a retropharyngeal abscess cause potential fatal infections further down the line?
The retropharyngeal space communicates with the mediastinum and so infection can spread here Also, the abscess can grow to cause airway obstruction and death from this
32
What investigations should be done to check for a retropharyngeal abscess?
CT Head and Neck is diagnostic | Side profile/lateral head and neck radiograph
33
What is the treatment for an peritonsillar/retropharyngeal abscess?
Incision and drainage | IV ABx
34
What is the most common cause of croup?
RSV Parainfluenza Adenovirus Influenza
35
What are the signs of croup?
Stridor Barking cough Hoarse Voice
36
During what time of year is croup more common?
Autumn
37
What are the symptoms of croup?
Prodrome of fever and nasal congestion Barking cough Hoarse voice Inspiratory stridor
38
What scoring system may be used to grade the severity of croup?
Westley Croup Score Grades croup as mild, moderate, severe or at risk of imminent respiratory failure
39
What is the medical name for croup?
Laryngotracheobronchitis
40
What is the treatment for mild croup?
If mild can be managed at home- anti pyrexial (e.g. paracetamol), keeping hydrated Single dose of dexamethasone may be given
41
What features might suggest croup is mild?
``` Limited signs of respiratory distress No IC, SC or Sternal Recession No tracheal tug Maintaining oxygen saturations Alert Child Good air entry ```
42
What are some signs that croup is severe?
``` Stridor at rest Tracheal tug IC or SC or Sternal Recession Restlessness Cyanosis Tachypnea Tachycardia Altered Consciousness ```
43
What is the management for severe croup?
Nebulised Adrenaline Dexamethasone If risk of respiratory failure or PEWS very high transfer to ITU, may need to be intubated
44
Failure to respond to initial treatment for croup (dexamethasone nebulized adrenaline) should raise concern of what?
Bacterial tracheitis- thick mucopurulent exudate is difficult to clear and can cause airway obstruction
45
What are some signs of epiglottis?
``` Sudden onset Continuous stridor Muffled voice high fever Cough not prominent (barking cough is seen with croup and bacterial tracheitis) ```
46
What should be avoided in children with suspected epiglottitis?
Avoid examining the throat as it can cause laryngospasm and occlude the airway. Avoid anything that stresses out the child. Get senior help with ENT/Anaesthetics. May need inhalational induction in theatre or a tracheotomy.
47
What is the most common cause of epiglottitis?
Haemophilus Influenzae B- rates have fallen as it is one of the routine vaccinations for newborns
48
What is the treatment of epiglottitis?
ABC approach and ensure patent airway Get senior help from ENT/Anaesthetics Cefotaxime Abx Note- Cough is absent unlike croup and bacterial tracheitis
49
What sign is seen on x-rays for epiglottitis?
Thumbprint sign- thickened epiglottis and aryepiglottic folds visible on a lateral x-ray Note- An x-ray should not be done in suspected cases, it is an emergency and an ENT/Anaesthetic senior should be sought
50
How does diphtheria cause harm?
Production of the toxin by the corynebacterium diptheria
51
What are some of the features of diphtheria initially?
Tonsillitis False membrane at the back of the throat Dysphagia Neck swelling Note- Diphtheria means leather in Greek because the membrane looks a bit like leather
52
What are some of the serious features of diphtheria?
Myocarditis Neuritis leading to paralysis Neck swelling- bull neck appearance
53
How is diphtheria prevented?
Vaccinate
54
How should diphtheria be treated?
Diphtheria antitoxin Erythromycin Give contacts erythromycin syrup before swab results are known. Isolate until 3 negative cultures separated by 48 hours.

Paediatrics (6 decks)

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