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Flashcards in Respiratory Deck (65)
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1

Name common conditions of respiratory illness in neonates.

Respiratory distress syndrome
Pneumonia
Chronic lung disease
Congenital lung malformations

2

Name common conditions of respiratory illness in infants.

Bronchiolitis
Pneumonia
Croup
CF
Chronic lung disease
Epiglottis

3

Name common conditions of respiratory illness in infants.

Viral induced wheeze
Croup
Pneumonia
CF
Epiglottitis

4

Common conditions over 5s

Asthma
Pneumonia
CF

5

Asthma
- How common
- When does it typically present
- Who is it hard to detect in

10-20%
Under 10s
Under 3s

6

History of asthma
- When is worst
- Fhx

- Expiratory wheeze, cough, chest tight, breathless
- worse @ night or morning
- Triggers
- Interval symptoms: sx between exacerbations
- PmHx/Fhx atopy
- +ve response to asthma Hx
-

7

Examination findings

Chest often normal
Hyperinflated if chronic
polyphonic expiratory wheeze & prolonged expiratory

8

What are Harrisons sulci?

Onset of disease in early childhood may result in Harrison’s sulci - depressions at the base of the thorax, associated with chronic obstructive airway disease in childhood

9

Diagnosis & investigations

Mostly diagnosed of Hx & examination
CXR to exclude other casue
PEFR (not useful if under 5)

10

Tx ladder under 5s

Step 1: Inhaled short-acting B2 agonist PRN
Step 2: Add inhaled steroid 200-400mcg/day
Step 3: Leukotriene receptor agonist (if under 2 go to step 4)
Step 4: refer to resp paed

11

Tx ladder 5-12

Step 1: Inhaled short-acting B2 agonist PRN
Step 2: Add inhaled steroid 200-400mcg/day
Step 3: add LABA
Step 4: ↑ steroid to 800mcg/day
Step 5: daily steroid tablet + refer resp paid

12

Side effects of steroid on children

Impaired growth → can affect height etc. Important to ask about hair growth, shoe size etc (inhibit growth plate & growth of bone)
Adrenal suppression
Oral candidiasis → important to tell parents to rinse child's mouth after taking steroid
Altered bone metabolism

13

Acute exacerbations of asthma

In acute asthma, the child will show signs of resp distress (intercostal regression, low O2 sats, ↑ RR). Hypoxia is the biggest threat to this child.

- high flow oxygen
- Bronchodilation
• Salbutamol
• Ipratropium bromide
- dose varies with age
- metered dose inhaler with spacer: size of spacer depends on age of child
- oxygen drived nebuliser
- steroids
• prednisolone 1mg/kg
• hydrocortisone IV 4mg/kg
- call for help (may require IV magnesium sulphate, aminophylline or salbutamol)

NB:
S.E. Salbutamol: hypokalaemia, tachycardia, tremor, lactic acidosis
• Can't do peak flow if < 5.

14

Bronchiolitis
- inflammation occur where
- due to what infection most commonly
- what does this inflammation cause

Bronchioles
usually due to respiratory syncytial virus (RSC = 80%)

↑ mucus production, bronchiolar obstruction in lower airways

15

What age group does it most commonly effect?
Any time of year?

1-9 months (rare after 12 months)
more common in winter

16

Which babies are at increased risk of bronchiolitis?

Congenital heart defects
Chronic lung disease of prematurity
Immunodeficient
Lung disease

17

Typical Hx

Coryza
Ex wheeze
sharp dry cough
worsening breathlessness
poor feeding
episodes of apnoea

18

Typical ex

cyanosis/pallor
tachy
subcostal & intercostal regression
chest hyper inflation: liver displaced downwards
prolonged expiration
wheeze & crackles

19

Investigate

Pulse ox
CxR: hyperinflation, atelectasis (lung collapse) & consolidation
Nasopharyngeal swab (antibody test for RSV)- if positive needs to be isolated

20

Management

Supportive Management
- Humidifed O2
- NG tube
- Bronchodilators

21

Croup
- What is it?

Mucosal inflammation & ↑ secretions anywhere from nose to lower airway.

22

What age group suffers from croup

6 months - 6 yrs

23

What is the cause

Usually due to a viral cause (95%)→
Influenza virus
Parainfluenza
RSV

24

Typical feature of croup

Barking cough
Harsh stridor
Hoaerseness
Fever
Coryza

Sx often start @ night, are worse @ night and develop over days.

25

Management

Often manage @ home, parents must observe child. Those < 1 have low threshold for hospitalisation.

Meds:
- oral dex, prednison & nebulised steroids ↓ severity
- in severe obstruction: nebuliser adrenaline via facemask

26

Epiglottisis
- cause
- main DD
- incidence
- common in which ages

H. influenzae type B
Croup
low due to Hib Vaccine
1-6

27

Clinical features of epiglotttitis

Onset of epiglottis is very acute & associated with →
High fever
Ill & toxic looking child
Intensely painful throat → prevents speaking, swelling and causes drooling
Soft inspiratory stridor
Child sitting immobile, upright with open mouth to optimise airway
Minimal or absent cough

28

Management
- admission?
- medication?
- famil

Urgent admission to ICU
Intubated (ETT)
Blood & venous access
Antibiotics: cefuroxime IV 7-10dyas
rifampicin for close contacts

29

In acute upper airway management what must you NOT do
- What should you do

- examine the throat
- ↓ anxiety
- monitor for signs of hypoxia
- severe: give adrenaline & call anaesthetist

30

List differences between croup & epiglottis
- Time course
- Prodrome
- Cough
- Feeding
- Fever
- Stridor
- voice

C: days E: hours
C: coryza E: none
C: bark E: none
C: can drink E: none
C no E: Y
C: rasping E: soft
C: hoarse E: absent