Pediatrics Flashcards
(27 cards)
Bronchiolitis definition
LRTI usually caused by RSV
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What is the most common LRTI in kids <2?
RSV Bronchiolitis (leading cause of hospitalizations in kids <1)
When is RSV season
starts Nov - Jan and lasts 4-5 months
What is the RSV prophylaxis?
Palivizumab for high risk (premies, lung condition, CHF)
Signs and symptoms of RSV Bronchiolitis
Sx: starts with URTI rhinorrhea, cough, fever and then develops into wheezing cough, crackles, tachypnea (>70) and desaturation (<96), nasal flaring, intercostal indrawing
Bronchiolitis differentials
Pneumonia
Asthma
Laryngotracheomalacia
Foreign body aspiration
GERD
CHF
Allergic reaction
Cystic Fibrosis
Bronchiolitis investigations
for classic picture, no investigations but can do chest x-ray if unsure
order bacterial culture if <3mo
management of bronchiolitis
For all patients:
- hydration
- nasal saline
- nasal suction
For severe:
- consider bronchodilator trial (prefer salbutamol over nebulizer epinephrine per uptodate)
- trial of steroids
mild - normal vitals, no accessory muscle use & normal feeding
- hydration
- nasal saline
- nasal suction
moderate - tachypneic, tachycardia, O2 90-95, minor accessory muscle use, difficulty feeding, dehydration
- need to go to ER if dehydrated or not eating
- oxygen, nasal saline, suction
severe and life threatening - nasal flaring, grunting, toxic, sweaty, irritable, marked dehydration, accessory muscle use
prevention of bronchiolitis
- hand hygiene
- avoid anyone sick Fall to Spring
- ensure immunizations are up to date (annual influenza over >6 months)
- breastfeeding passes antibodies
- avoid smoking (risk factor and more severe dx)
- prophylaxis for high risk
- Beyfortus (new monoclonal) for those <8months during RSV season - single IM dose
tips to manage bronchiolitis at home
Beyfortus® (nirsevimab)
monoclonal antibody to protect against RSV
- infants entering first RSV season or born during RSV season (Nov - April ish)
- high risk kids up to 24 months during second RSV season (chronic lung disease, Down syndrome, CF, CHD,
Recommendations for common cold in kids
NSAIDs for comfort
Honey >1yo
Consider echinacea and vitamin c
Consider humidified air
*NO antitussives/cold meds <6yo
*NO decongestants
*NO zinc
Kids have on average 6-8 colds/year
differentials for ear ache in a kid
acute otitis media - infection
otitis media with effusion - fluid but no ix
myringitis - inflamed tympanic membrane
chronic suppurative otitis media - perforated tympanic membrane and drainage for >6 weeks
myringitis
- inflamed tympanic membrane
- alone or with otitis external
chronic suppurative otitis media
- perforated tympanic membrane and drainage for >6 weeks
when is peak incidence of AOM
6-9 months
risk factors of AOM
- family history
- smoking exposure
- pacifier use
- lying flat feeding
- short breastfeeding duration
- daycare, exposure to kids
- enlarged tonsils, cleft palate
symptoms of AOM
ear tugging/pain
vomiting
fever
poor feeding
rhinitis
if child with AOM is <6 months, do you treat?
Yes, always
8month old with perforated AOM and purulent discharge, tx?
antibiotics x 10d
- amoxicillin
- escalate to augmentin if not improving
When do you watch and wait in AOM?
if mild symptoms (no high fever), <48hours
can observe 24-48hours - delayed prescription method
When do you rx antibiotics for AOM?
- If perforated TM with purulent discharge
- if >48 hours and moderate/severe
- if getting worse after watch & wait 24-48 hours
What is the typical course for AOM
80-90% will have resolution of fever and pain in 2-3 days, complete resolution by 7d without treatment
treatment for AOM?
Amoxicillin suspension 80mg/kg/day divided BID
OR Augmentin
If allergy - cefprozil or cefuroxime or clarithro/azithro (third line)
