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Flashcards in Pulm Deck (25)
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1

Tx for asthma

Patient ed: use of spacer, shaking canister, home monitoring, prevention or environment control

SaβAs: albuterol, levalbuterol

LaβAs: salmeterol, formoterol

Inhaled steroids

Anticholinergics aren’t as helpful in kids

Mast cell stabilizers: cromolyn, nedocromil

Leukotriene inhibitors

Refer for acute life-threatening attack, mod-severe asthma, steroid-dependent asthma, complicated asthma, poor response to optimal therapy

2

SaβAs

albuterol, levalbuterol

3

LaβAs

salmeterol, formoterol

4

Inhaled steroids

beclomethasone (required trial for Medicaid), fluticasone, budesonide, mometasone, ciclesonide, triamcinolone, flunisolide

5

Mast cell stabilizers

cromolyn, nedocromil

6

Leukotriene inhibitors

montelukast, zileuton, zafirlukast

7

Croup etiology

Usually parainfluenza virus

8

Croup presenttaion

Stridor, hoarseness, barking seal cough, low-grade fever

Rales, rhonchi, wheezing

Sx worse at night

9

Croup tx

Supportive: cool mist humidifier

Send to ED for inhaled epinephrine if severe or if there is stridor at rest

Steroids

10

Acute bronchiolitis etiology

RSV

11

Acute bronchiolitis presentation

Rhinorrhea, sneezing, wheezing, low grade fever, nasal flaring, tachypnea, retractions that indicate respiratory distress

12

Acute bronchiolitis w/u

Nasal washings for RSV cx and antigen assay

Nrml CBC and CXR

13

Acute bronchiolitis tx

Hospitalize and admin ribavirin

Supportive tx- nebulized albuterol, IV fluids, antipyretics, chest physiotherapy, humidified O2

14

signs of upper airway foreign body

causes abrupt onset of cough, stridor, choking, and cyanosis; complete obstruction leads to inability to cough or choke

15

signs of lower airway foreign body

causes acute to subacute cough, unilateral persistent wheezing, and recurrent pneumonia; complete obstruction may cause a ball valve effect, resulting in distal hyperinflation and mediastinal shift, which is most apparent on expiratory films

16

cystic fibrosis tx

Clearance of airway secretions, reversal of bronchoconstriction,
tx of respiratory infections, replacement of pancreatic enzymes, and nutritional and psychosocial support

17

Hyaline Membrane Disease presentation

Respiratory distress and cyanosis soon after birth (usually w/in first 4 hr of life)

Tachypnea, tachycardia, chest wall retractions, nasal flaring, abd breathing

18

Hyaline Membrane Disease tx

Inpatient with fluid balance, CPAP, exogenous surfactant

Prevention: betamethasone for women at risk for preterm deliery prior to 34 wks
If >30 wks FLM can be tested by amniocentesis

19

Hyaline Membrane Disease w/u

CXR →x diffuse ground glass appearance w/ air bronchogram

20

Pneumonia etiology

Bacterial: Strep pneumo, S. pyogens, S. aureus, H. flu, M. pneumo

Viral: RSV, influenza, parainfluenza, adenovirus

21

Pneumonia presentation

Tachypnea, hyoxemia, ↑ work of breathing, fever, productive cough, difficult feedings

Crackles, ↓ breath sounds, dullness to percussion, egophany

22

Pneumonia tx

Inpatient → IV ampicillin is 1st line, 2nd or 3rd gen cephalosporins w/ or w/o vanc, consider macrolide (in 1-3 mo)

Outpatient → first line is high dose amoxicillin alt is 2nd or 3rd gen cephalosporins or azithromycin(should have nrml O2 sat and be able to take oral fluids)

23

RSV tx

Supportive

May need hospitalization w/ fluid and respiratory support

Albuterol trial, Steroids (not for infants)

Ribavirin for select infants

24

Who should get vaccinated for RSV

Preemies <32 wks or who are <3 mo at start of RSV season CLD, heart defect, asthma, immunocomp

25

when is RSV season

beg in oct and end in march