Paeds resp Flashcards
(35 cards)
Presentation of whooping cough/pertussis
Initial symptoms: low grade fever, mild coryzal sx, mild dry cough.
Develop severe coughing fits after a week with an inspiratory whoop after coughing ends.
Diagnosing pertussis
Nasal/nasopharyngeal swab with PCR/bac culture in first few weeks.
If cough for over 2 weeks, can test for anti-pertussis toxin IgG.
Mx and prognosis of pertussis
- Notifiable disease
- Supportive care, admit if vulnerable/acutely unwell: severe coughing fits, cyanosis, apnoeas.
- Can use macrolides in first few weeks.
- Sx resolve in 8 weeks.
Complication of pertussis
Bronchiectasis
Who should be vaccinated against pertussis?
Young children and pregnant ladies
What does bronchiolitis describe?
Infection and inflammation of the bronchioles (small airways). As the bronchioles of infants are so small, even a small amount of inflammation can have a significant effect on breath sounds.
Most common cause of bronchiolitis
Usually viral, RSV
Age group affected by bronchiolitis
Under 1yrs, particularly under 6 month olds in winter.
How does bronchiolitis present?
Mild fever, coryzal sx (sneeze, runny nose, watery eyes, mucus in throat, cough), poor feeding, tachypnoea, dyspnoea, apnoeas (periods of not breathing), signs of respiratory distress.
Signs of respiratory distress
Head bobbing Nasal flaring Tracheal tug Cyanosis Use of accessory muscles (abdominal, intercostal, sternocleidomastoid) Intercostal and subcostal recessions Abnormal airway noises
Abnormal airway sounds
Wheeze
Stridor (high pitched inspiratory noise, e.g. croup)
Grunting
Typical RSV course for bronchiolitis
Starts as URTI with coryzal sx. Half then get better, half will develop chest sx 1-2 days after onset of coryzal sx.
Sx usually worst on day 3/4. Last 7-10 days. Recover fully in 2-3 weeks.
Mx of bronchiolitis at home
Most can be mx at home: ensure adequate feeding and can use saline nasal drops to clear secretions. Safety net- if feeding falls to 50-75%, signs of respiratory distress, feel unable to manage.
When would you admit for bronchiolitis?
- Under 3m, down’s, CF, premature
- sats below 92%
- RR above 70
- Signs of r.distress, apnoeas
- Dehyrdated, 50-75% of normal feeding
Mx of bronchiolitis in hospital
- Adequate intake (oral, NG, IV). Small, frequent feeds, gradually increase them as tolerated. Too full = restricts breathing.
- Saline nasal drops/suctioning
- O2 if <92%
- Ventilatory support if required- do CBG
Blood gas results for poor ventilation
Rising CO2- airways have collapsed and can’t clear CO2
Falling pH- respiratory acidosis
What is palivizumab used for?
Monthly injections of a monoclonal AB for ex-premature + congenital heart disease children. Provides passive protection.
Having bronchiolitis as an infant increases the chances of developing what condition in childhood?
Viral wheeze.
Features of viral induced wheeze vs. asthma
- Presenting before 3 years
- No hx of atopy
- Only occurs during viral infections
Symptoms and signs of viral wheeze
Preceeding viral illness (fever, cough, coryzal) 1-2 days before signs:
- SOB
- Signs of r.distress
- Expiratory wheeze throughout chest (SHOULD NOT BE FOCAL)
Mx of viral wheeze
Same as acute asthma in kids.
What does epiglottitis describe?
Inflammation/swelling of epiglottis caused by infection, usually Haem. infleunza B. Within hours, it can swell to the point of completely obscuring the airway- life threatening emergency.
Included in routine vaccinations but beware in unvaccinated children.
How does epiglottitis typically present?
Unvaccinated child with fever, sore throat, stridor, drooling, sat forward in tripod position (sat forward with a hand on each knee).
May appear septic, distressed, quiet voice, difficulty swallowing.
Investigations for epiglottitis
If acutely unwell + suspect epiglottitis, don’t perform inv.
- Lateral X-ray of neck shows thumbprint sign (oedematous, swollen epiglottis). Excludes foreign body also.
