Respiratory Flashcards
(21 cards)
What is the typical presentation of bronchiolits?
- coryzal prodrome of nasal discharge, sneezing, sore throat
- followed by cough
- reduced wet nappies (indication of dehydration)
- fine crackles throughout lungs, increased RR
- poor feeding
What is the cause of bronchiolitis?
RSV
What are the risk factors for bronchiolitis?
infant <1years, winter, cystic fibrosis, prematurity
What is the emergency Mx for bronchiolitis?
- Nasal suction for secretions
- Oxygen maintain >92% via nasal cannula, if deteriorating give CPAP (continuous positive airway pressure)
- Fluids NG or IV
- discharge with safety netting advice e.g., red flags
What is the community Mx for bronchiolitis?
- Advise parents bronchiolitis is self-limiting, resolves within 3-5 days, no abx needed
- Antipyretics if child distressed due to fever
- hydrate with fluids
What are the red flags for admission of respiratory symptoms in children?
- Respiratory distress red flags: decreased consciousness, cyanosis, Intercostal/subcostal recession, tracheal tug, nasal flaring
- RR >60/min
- SpO2 <92%
- Reduced feeding/dehydration
What is the presentation of cystic fibrosis?
- chronic cough
- thick sputum
- neonatal period (around 20%): meconium ileus (first sign of cystic fibrosis), this is a small bowel obstruction caused by thickened meconium
- recurrent chest infections (40%)
- malabsorption (30%): steatorrhoea (loose smelly, greasy stools),
- failure to thrive
What is the investigations for cystic fibrosis?
-Sweat test (GOLD standard): diagnostic chloride concentration from sweat.
What screening is conducted for cystic fibrosis?
- New-born bloodspot test: cystic fibrosis screened at birth.
- Genetic testing: for CFTR gene from amniocentesis or chorionic villous sampling during pregnancy.
What are the complications of cystic fibrosis?
- 90% will develop pancreatic insufficiency (due to blockage of ducts causing lack of pancreatic lipase)
- liver disease
- can cause early onset of diabetes, presents with random blood glucose >11, polyuria, polydipsia
- most males are infertile to due absent vas deferens
What is neonatal sepsis?
Neonatal sepsis occurs when a serious bacterial or viral infection in the blood affects babies within the first 28 days of life.
What is the most common cause of neonatal sepsis?
Group B streptococcus (GBS) and Escherichia coli,
Presentation of neonatal sepsis?
Respiratory distress - grunting, nasal flaring, using accessory respiratory muscles, tachycardia
Investigations for neonatal sepsis?
- Two blood cultures to distinguish from contamination
- FBC will show neutrophilia
- CRP raised
Mx for neonatal sepsis?
1)IV Benzylpenicillin with gentamicin
What is croup and most common cause?
Croup is an URTI in infants and toddlers <3years, inflammation of larynx, trachea and bronchi (laryngotracheobronchitis)
-commonly caused by parainfluenza virus
What is the presentation for croup?
- Barking cough
- stridor on inspiration
- symptoms worse at nice or with agitation
- coryzal symptoms
What are the investigations for croup?
-the vast majority of children are diagnosed clinically
however, if a chest x-ray is done: will show subglottic narrowing, commonly called the ‘steeple sign’
What is the Mx for mild croup
- Advise croup is self-limiting and resolves within 48h
- paracetamol or ibuprofen for fever and pain
- keep child calm
1) Oral dexamethasone (0.15mg/kg) single dose
What is the Mx for moderate/severe croup?
Admit to hospital if moderate/severe
- Summon immediate anaesthetic help for airway intubation
- Oxygen keep >92%
1) Oral dexamethasone (0.15mg/kg) single dose
2) Nebulised prednisolone as alternative if cannot tolerate dexamethasone - Nebulised adrenaline in emergency
What are the red flag signs for nice traffic lights system in feverish child (5)?
- Moderate or severe chest wall recession
- Does not wake if roused
- Reduced skin turgor
- Mottled or blue appearance
- Grunting
