Pulm Lecture Flashcards by Cassidy Ruocco

Larger head
Smaller mandible, small neck
Large tongue, posteriorly placed
Tonsils and adenoids present
Smaller airways
Less rigid throacic cage
Increased metabolick rate
Increased O2 demand

Differences of pediatric respiratory system

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Tachycardia
Retractions- intercostal and sternal
Grunting, nasal flaring
Head bobbing
Abnormal breathing
Tripod position

Pediatric respiratory distress

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Laryngotracheobronchitis, AKA

Croup

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Pathophys: parainfluenza, affects the larynx
causes subglottic edema, airflow obstruction

Affects ages 6 mos to 3 years
males>females
Fall, early winter MC

Croup

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“Seal, barky” cough
Inspiratory stridor
Respiratory distress (retractions), low O2 stats, cynosis, sometimes low grade fever

coughing fits at night (due to increased edema)

Croup

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Diagnosis:

Clinical diagnosis
Steeple sign on CXR

Croup

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Tx:
Single dose of Decadron
Moist vs cool air, tylenol for fever

Croup

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Bacterial infection with H. influenza
Affects the epiglottis with cellulitis/edema
causes airway obstruction

affects kids 4-7 yo
decreased incidence due to HiB vaccination

Epiglottitis

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Rapid onset, severe distress within hours
High fever, difficulty swallowing or sore throat
drooling, stridor
No cough*
TRIPOD POSITION

Epiglottitis

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DO NOT ATTEMPT TO VISUALIZE AIRWAY

lateral soft tissue neck X ray shows thumb sign

**this is a medical emergency!!

Epiglottitis

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Tx:

Antipyretics for fever
IV antibiotics (Rocephin)
Secure airway- may need to intubate

Epiglottitis

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Acute respiratory infection caused by influenza A or B
Present winter months, community outbreaks
Vaccine for prevention (do not give if pt has egg allergy)
Affects adults and children

s/s: myalgias, fever, chills, runny nose, HA, sore throat

Dx: PCR nasal swab

Tx: antipyretcs, tamiflu within 48 hours of sxs

Influenza

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AKA Bronchiolitis (inflamed bronchial tubes)
RNA paramyxovirus
Causes air trapping
Seasonal airbreaks (mostly during winter)

children under 2 (peak incidence at 6 mos)

Respiratory Syncytial Virus (RSV)

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S/S:

Recent URI exposure, increase in nasal congestion, cough
gradual onset of respiratory distress
fever, poor feeding, expiratory wheezing
“junky” lung sounds, retractions, tachypnea, low O2 sat

RSV

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Dx:
Nasal swab
hyperinflation on CXR

Tx:
Supportive tx, self-limited

RSV

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“whooping cough”
All ages of children

3 stages:

catarrhal stage: 1-2 weeks, URI symptoms, fever, cough, runny nose
paroxysmal stage: 1-6 weeks, post tussive vomiting, inspiratory whoop
convalescent stage: 2-3 weeks, cough lessens

Pertussis

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Which stage of pertussis lasts 1-6 weeks and consists of:
post-tussive vomiting
inspiratory whoop

Paroxysmal stage

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What stage of pertussis lasts 1-2 weeks and consists of:
URI symptoms
Fever
Cough
Runny nose

Catarrhal stage

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Which stage of pertussis is the recovery stage that lasts 2-3 weeks, cough lessens

Convalescent stage

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Dx: culture/PCR nasal swab

Tx: macrolide antibiotics (Azithro, Clarithro)
**treat all family members***

Pertussis

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Infection of the lower respiratory tract
MC pathogens: strep pneumonia, H.influezae, mycoplasma

Pneumonia

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S/S:

Fever, cough
rapid breathing/tachypnea
dypnea
low oxygen sat
lethargy
focal crackles/rales on ausculation

Pneumonia

Dx:
CXR shows consolidation, “round appearing”
CBC shows WBC > 15k

Tx:
Amoxicillin (1st choice)
or Macrolide (Azithro)

Pneumonia

Pneumonia in a child with….

Oxygen sat <92%
RR >70 in infant or >50 in child
Intermittent apnea or grunting
Dehydration
Family unreliable

Admit!

When should a child follow up with a pediatrician after a pneumonia dx?

within 24-48 hours

Viral or bacteria pneumonia?: Gradual onset Recent URI symptoms CXR shows interstitial infiltrates

Viral pneumonia

Genetic-multi systemic disease. avg survival is 38 years abnormality in the **cystic fibrosis transmembrane conductance regulator (CFTR)** **abnormalities of salt and water transport across epithelial surfaces** affecting the lungs and GI system **\*MUCUS RETENTION**

Cystic fibrosis

**Pancreas dysfunction**: calorie malabsorption bc pancreas becomes obstructed **Lung disease**: cycle of mucus retention, injection and inflammation

Cystic fibrosis

S/S: Positive newborn screen (elevated ImmunoReactive Trypsinogen) **Failure to pass meconium at birth**, or bowel obstruction at birth Recurrent respiratory infections! (thick mucus, wheezing, cough) greasy, foul smelling stools that float 99% of males are sterile clubbing of fingers

Cystic fibrosis

Dx: **positive sweat test \> 60 mEq/L** Tx: mucus thinners, airways clearance (chest PT), inhalers, lung transplant, frequent abx, supplemental pancreas enzymes, etc

Cystic fibrosis

Lower airway hypersensitivity to: allergies, irritants, exercise, infection **chronic airway inflammatory disorder affecting mast cells, eosinophils, lymphocytes** inflammation --\>bronchospasm --\>bronchial edema --\>increased mucus

Asthma

S/S: Episodic dry cough **wheezing** respiratory distress (nasal flaring, retractions) reucrrent symptoms, presence of triggers (exercise, cold air, allergens) associated with nasal polyps and atopic dermatitis

Asthma

Dx: PFTs Spirometry shows \< FEV1:FVC ratio Spirometry pre and post bronchodilator with a 12% improvement of FEV1 **CXR shows hyperinflation** Methacholine challenge- causes bronchoconstriction

Asthma

Tx: Bronchodilators Beta2 agonists Inhaled steroids

Asthma

SIDS occurs during sleep in what age group?

less than 1 yo ## Footnote **peaks 2-4 months**

Exposure to cigarette smoke Maternal age under 20 Prematurity and low birth weight Prone sleeping position ("back is best") Soft bedding (no pillows, toys, blankets in crib) Overheating Bed sharing not recommended under 3 months old

Risk factors for SIDS

Siblings of SIDS victim increases risk _____ fold

5-6 fold

Room sharing Breast feeding Use of pacifier during sleep Place infant on back to sleep

Methods to reduce SIDS

Hyaline membrane disease is a deficinecy in...

Surfactant

Asthma symptoms less than 2 days a week is what classification?

Intermittent

symptoms \>2 times a week, but **not daily** night time awakenings 3-4 times a month use SABA \>2 times a week, not daily what classification of asthma?

Mild persistent asthma

Symptoms daily Awaken \>1 time a week but not daily Use SABA daily what classification of asthma?

Moderate persistent asthma

Symptoms daily throughout the day Awaken at night ~7 times a week Used SABA several times a day what classification of asthma?

Severe persistent

Step 1 for asthma treatment?

SABA PRN (ie albuterol)

Step 2 asthma tx?

Low dose inhaled glucocorticoids (**step 3 would be medium dose inhaled glucocorticoids**)

Failed therapy of asthma with medium dose inhaled glucocorticoids alone, what is the next time?

Add a LABA

\_\_\_\_\_\_ maintains alveoli stability and inflation \*if deficient, no inspiratory pressure to inflate alveolar units, causing atelectasis

surfactant

What population is hyaline membrane disease seen in?

Premature infants! (under 37 weeks)

Signs of respiratory distress a few hours after birth Cyanosis, hypoxemia CXR shows **ground glass appearance** Tx: Corticosteroids (during labor) Surfactant

Hyaline membrane disease

What tx is used in Hyaline Membrane Dz because it induces the formation of surfactant in the fetal lung

Corticosteroids (give during labor)

S/S: upper airway: stridor, choking, cough, cyanosis, not phonating if complete obstruction, no cough or choking lower airway: unilateral wheezing, recurrent pneumonia, cough Dx with CXR

Foreign body aspiration

Should you do a blind finger sweep with finger in the oral cavity?

Tx: Infant: back blows, chest thrusts Child: abdominal thrusts

Foreign body aspiration