Resp Flashcards
What is the aetiology of Croup?
Croup: laryngotracheobronchitis
Usually Virual with infection of
- parainfluenza Virus (75%)
- can be caused by other resp. viruses (e.g. RSV)
What is a typical presentation of Croup’s?
1-3 days of cryozal symptoms
followed by
2-7 days of
- stridor, braking cough, potential wheeze
- intercostal recession
What score is used to classify croup based on severity?
- Westly score
What parameters are used in the Westly score for classification of Croup?
What are the red flags for Croup?
- Chest wall recession
- Stridor
- Cyanosis
- Decreased consciousness/ orientation
- Air entry
In what levels of severity is croup classified?
What are the characteristics?
Mild croup
- Barking cough, no stridor/sternal intercostal recession
Moderate
- Stridor, dyspnoea at rest, pronounced thoracic retractions, pallor, tachycardia >160/min, but no lethargy or agitation
Severe
- Barking cough with stridor, sternal/intercostal recession associated with agitation or lethargy
Impending respiratory failure
- Minimal barking cough, stridor may become harder to hear
- Increasing Upper airway obstruction, sternal -
- Fatigue, pallor, cyanosis
- Resp rate >70 breaths/minute
What is the management of Mild croup?
Mild croup
- Barking cough, no stridor/sternal intercostal recession
- Cold, humid air works best
- Oxygen
- oral dexamethasone (0.15 - 3mg/kg) immediately
What is the managmement Croup if hospital admission is required?
- Nebulised adrenaline (1:1.000)
- Corticosteroids
1) Nebulised Budesonide 2mg (as single dosed)
2) Dexamethasone Oral (0.15 mg/kg)
3) Dexamethasone IM (0.6mg/kg)
What are indicators for hospital admission in croup?
a. Ongoing Work of Breathing
b. If adrenaline neb given
c. If patient history of Severe croup
d. Upper Airway problems
How would you safety net a patient with mild croup after recieving the dexamethasone?
i. Continuous stridor
ii. Increased work of breathing
iii. Agitation and restlessness of child
iv. Cyanosis + severe respiratory distress, impaired consciousness
What is the usual age of presentation for croup?
6 months - 2 years (up to 4 years)
What is the epidemiology of cystic fibrosis?
Most common in northern european (1:25 is carrier), 1:2.500 children in the uk
Usually presents early in childhood (picked up on UK newborn screen)
What is the genetic mutation causing CF?
Several mutations for the CFTR gene on chromosome 7
Most common: delta- F508 gene resulting in flase CFTR transporter
Explain the pathophystiology of CF
Chloride cannot be excreted to the surface –> high intracellular chloride concentrations
Increased Na+ resorption into cell to even out chloride/ sodium equilibrium –> increased H20 diffusion into cell –> hyperviscous mucus –>
accumulation + blockage of small passages in organs – > inflammation and end-organ damage
In sweat glands the process is the other way around and CL- reabsorbtion is inhibited –> high NaCl concentratios in sweat
How will most children with CF present?
- 20% present with meconium ileus at birth
- Most others will be picked up on newborn test
**Others include **
- Pancreatic insufficiency (steatorrhea + malabsorption in children) otherwise often first presentation
- Recurrent chest infection
- Failure to thrive
How is CF screend for?
a. Immunoreactive Trypsinogen test during newborn screening
i. Not diagnostic if positive, if positive should be referred to CF centre and
