Respiratory - paeds Flashcards
(23 cards)
What is croup?
An acute URTI causing oedema in the larynx in young children (often 6 months to 2 years)
Causes of croup
- parainfluenza virus
- influenza
- adenovirus
- RSV (respiratory syncytial virus)
Presentation of croup
- barking cough
- hoarse voice
- stidor
- increased work of breathing
- low grade fever
CXR finding of croup
PA view shows supraglottic narrowing ‘steeple sign’
Management of croup
- Mainly managed at home with fluid + rest
- hand washing + stay off school
- single dose oral dexamethasone
Stepwise management of croup in severe cases
- oral dexamethasone
- oxygen
- nebulised budesonide
- nebulised adrenaline
- intubation + ventilations
What is bronchiolitis?
Inflammation and infection of the bronchioles
Occurs in children under 1
Cause of bronchiolitis
RSV
Respiratory syncytial virus
Presentation of bronchiolitis
- coryzal symptoms: snotty nose, sneezing, watery eyes
- signs of respiratory distress
- dyspnoea
- Tachypnoea
- apnoea episodes
- poor feeding
- wheeze + crackles of auscultation
What are coryzal symptoms?
Examples
Typical symptoms of viral URTI
e.g runny nose, sneezing, mucous in throat, watery eyes
Signs of respiratory distress in children
- raised RR
- use of accessory muscles
- nasal flares
- head bobbing
- tracheal tugging
- intercostal + subcostal recessions
- cyanosis
- abnormal airway noises
Examples of abnormal airway nosies
What they are due to
- wheeze: whistling sound during expiration due to narrowed airways
- grunting: caused by exhaling with glottis partially closed due to increased +ve end expiratory pressure
- stidor: high pitched inspiratory noise due to upper airway obstruction
Reasons for hospital admission in bronchiolitis
- under <3 months
- pre existing conditions e.g. premature, Down’s syndrome, cystic fibrosis
- <50-75% of normal intake of milk
- clinical dehydration
- RR >70
- O2 sats <92%
- signs of severe respiratory distress
- apnoeas
- parents not confident in ability to manage at home
Management of bronchiolitis
- adequate intake: start with small frequent feeds and gradually increase
- saline nasal drops + nasal sanctions
- supplementary O2
- ventilatory support if required e.g. high flow humidified oxygen, CPAP, intubation + ventilation
Describe high flow humidified oxygen as ventilatory support
- administer via tight nasal cannula
- delivers air + O2 conscientiously with some added pressure
- adds positive end expiratory pressure to maintain airway at end of expiration
What drug can be used against RSV?
How does it work?
Who is it given to?
- palivizumab
- monthly injections given as prevention > provides passive protection
- given to high risk babies e.g. premature, congenital heart disease
What is epiglottitis?
inflammation of epiglottis caused by haemophilus influenzae type B
what is epiglottitis caused by?
haemophilus influenzae B
why has the incidence of epiglotitis redcuced?
haem influenzae B vaccine
features of epiglottitis
- rapid onset
- high fever
- stidor
- drooling of saliva
- tripod position - pt finds it easier ot breathe when sitting leaning forward + extending neck in seated position
diagnosis of epiglottitis
- direct visualisation
- CXR - swollen epiglotitis thumb sign
management of epiglottitis
- immediate senior involvement - ENT + anaesthetics
- endotracheal intubation
- O2
- IV abx
Causes of stridor in children
Forgein body aspiration
Croup
Epiglottis
Laryngomalacia
