Respiratory- Paeds Flashcards
(36 cards)
What are the commonest Respiratory infections?
Preschool- 6-8 reso infx per year
Life threatening- bronchiolotis, pneumonia
Pathogens:
Viruses-80-90%
Resp syncytial virus- (RSV), rhinovirus, parainfluenza, influenza, metaoneumovirus, adenovirus.
RSV- spectrum of illnesess; bronchiolitis, croup, pneumonia or a common cold.
Bacterial:
Strep pneumoniae (pneumococcus), Haemophilus influenzae,
Moraxella catarrhalis, Bordetella pertusis- whooping cough,
Mycoplasma pneumoniae.
TB globally.
Dual inx- 2 viruses or V+B
Epidemics- RSV every winter.
What are some host and environmental fx affecting resp infx?
⬆️ risk
Parental smoking esp maternal
Poor socioeconomic status + large family, overcrouded, damp housing
Poor nutrition
Male
Immunodeficiency- 1o or 2o HIV infc, chemo
Haemodynamically significant Congenital heart disease
Underlying lung disease:
Bronchopulmonary dysplesia (02 requirments) in preterms, CF, asthma.
Greatest admission and mortality risk: infants
Increased risk when starts nursery or school.
Resp infx- common, rarely indicate undrelying disease.
Howmdo we classify resp infx?
According to level of infx URTI Laryngeal/ tracheal infx Bronchitis Pneumonia
URTI - what are the SS?
80% involve throat, nose or ears. URTI--> Commom cold (coryza) Sore throat (pharyngitis incl tonsilitis) Acute otitis media Sinusitis (uncommon)
PC
Nasal discharge + blockage,
Fever
Painful throat + earache. Cough depends.
URTIs may cause:
Nose closed- obstructed breathing–> so diff feeding
Febrile convolusions
Acute exacerbations of asthma.
Infants- admit to exclude severe if feeding inadequate or parental reassuarance.
What happens in common colds?
Coryza- commonest childhood infection
CF–> clear or mucopurulent nasal discharge and nasal blockage.
Commonest- viruses–> rhinoviruses (100 diff serotypes) , coronaviruses, + RSV.
Fever + pain- paracetamol + ibuprofen.
Educate- no cure
Antibiotics- not indicated as no benefit + secondary bacterialninfx is uncommon.
Sore throat- pharingitis- what happens?
Phranyx and palate are inflamed - local lymph nodes are enlarged + tender.
Mostly viral- adenoviruses, enteroviruses, rhinoviruses commonest.
Older children–> group A b- haemolytic streptococcus
Tonsilitis- what happens?
Form of pharingitis- intense inflamation of tonsils + purulent exudate (aspruthkia)
Common pathogens:
Group A b-haemolytic streptococci( usually aldready lives there) + Epsein- Barr virus (EBV) -> infectious mononucleosis.
Cannot distinguish clinically if V or B cause of tonsilitis.
Bacterial infx- common assc sx->
Secere pharingitis + tonsilitis antibiotics- penicillin or erythromycin if pen allergic
Even tho inly 1/3 is B.
Streptococcal- havest all- to avoid rheumatic fever- 10 D tx required (not in UK cz reumatic fever rare)
If unable to swollow fluids or foods- admit IV fluids and analgesia.
Amoxicillin avoided- might caise maculopapular rash if tonsilitis due to infectious mononucleoisis.m
Whats infectious mononucleosis?
MO
Glandular fever
Kissing disease
Transmission by Saliva
Widespread viral disease mostly by EBV (herpes family)
PC- fever, malaise, fever, sore throat.
Amoxicillin contraindicated- spreads them..?
What hapoens in the acute infx of middle ear?
Acute otitis media (OM)
Nost kids have at least one
Coomonest at 6-12M
20% will have 2-3 episodes
Infants + young children- prone cz Eustachian tubes short, horizontal and function poorly.
CF-
Pain in ear and fever ! Every kid with fever must have their tympanic membranes examined.
Bright and red + bulging w/ loss of normal light reflection.
Occasionally- acute perforation of eardrum with pus visible in external canal.
Pathogens- viruses - esp RSV + rhinovirus
B- pneumococcus, H influenza (non- typeable) + Moraxslla catarrhalis.
Serious complications:
Mastoditis, meningitis (uncommon)
Pain- analgesia- paracetamol, ibuprofen - regular better than intermittent
Most cases resolve spontaneously
Antibiotics shorten pain duration but not proven to reduce hear loss.
Give prescription but ask parents to take it only if kid unwell after 2-3 days.
Amoxicillin used. Antihistamimes not beneficial..
Whats the glue ear?
Recurrent ear infx- ottitis media with effusin - glue ear.
Asymptomatic apart from hearloss.
Eardrum- dull and retracted , often fluid visible.
Confirm- flat trace on tympanometry + evidence of conduction loss on pure tone audiometry (possible if >4Y)
Or reduced hearing on distraction hearing test.
Common2-7 Y peak 2.5-5Y
No effect on hear loss : antibiotics and steroids.
Can develop speech delays –> learning diff at schl.
Insert ventilation tube ( grommets)
Adenoidectomy more long benefit.
Why- adenoids harvest organisms within biofilms that contribute to infx being carried to eustachian tubes.
+ grossly enlarged adenoids may obstruct the tubes fx leading to poor ventilatiom of middle ear,
Kids with recurrent URTis and chronic glue ear do not resolve conservativley.
If problems occur after grommet insertion , reinsertion with adenoidecromu advocated
Whats Sinusitis?
Infx ofnparanasal sinuses- from viral URTIs
2o bact infx- pain, swelling, tenderness over cheeck from maxillary sinus infx
Frontal sinuses develop in late childhoood- frontal sinusotis uncommon before 10Y
Acute sinusitis- antibiotics, analgesia + topical decongestants.
When do you condsider tonsillectomy and adenoidectomy?
Shrink in late chilhood.
Commonest operation in kods- recurrents tonsilitis
Balance with risks of surgery:
1. Recurrent severe tonsilitis (not URtIs, tonsilectomy reduces number of episodes of tonsilitis by 1/3.
2. Peritonsilar abscess
3. Obstructive sleep apnoea- adenoids usually removed as well.
Adenoids increase in size till 8Y
Young- grow faster than airway 2-8Y narrowing of airway.
If nasal space efficiently narrowed.. Adenoidectomy
Indications for both being removed:
Recurrent otitis media w/ effusions w/ hearing loss.
Obstructive sleep apnoea (absolute indication)
Whatbare some DD of acute Upper airways obstruction?
Common: viral laryngotracheobromhotis - croup, very common.
Rare causes Epiglottitis Bacterial tracheatis Inhalation of smoke and hot air fumes Trauma to throat Allergic lanyngeal angioedema - seen in anaphylaxis and recurrent croup Hypocalcaemia due to poor VitD intake Infectious mononucleosis- severe lymph node swelling Measels Diptheria Laryngeal foreign body Retropharyngeal abscess
What hapoens in laryngeal and tracheal infiections?
Young children- mucasal inflammation and swelling- produced by tracheal and laryngeal infections can rapidly cause life- threatening obstruction of the airway.
Severe conditions can cause upper airway obstruction:
A.Stridor- rasping sound heard predominantly on Inspiration.
B. Hoarsness due to inflammation of vocal cords
C. Barking cough like sea lion
D. Variable degree of dyspnoea.
Severity - clinically by chest retraction( paei mesa) - subcostal, intercostal, sternal recession - better indicator than RR.
None, only on crying, at rest.
Degree of stridor- none, only crying, at rest, biophasic.
Severe obstruction–> ⬆️RR, HR, agitation.
⬆️ hypoxia + need for urgent intervention-> central cyanosis or drowsiness.
Most reliable hypoxaemia measure- oxygen saturation by pulse oximetry.
Total obstruction of upper airaway may be precipitated by examining the throat using spatula.
Avoid unless full resuscitation equipment and personnel are at hand.
How do you manage acute upper airway obstruction?
DO not examine throat ❗️ ❌
Reduce anxiety by being calm, confident, well prganised.
Onserve carefully for signs of hypoxia or deterioration.
If severe-
Administer nebulised epinephrine (adrenaline) + contact anaesthetist.
If Resp F develops (⬇️O2) from increasing airway obstruction, exhaustion or secretions blocking airways- urgent tracheal intubation is required.
What are the effects of epinephrine in anaphylaxis?
Upper airway obstruction
Administered nebulised: (inhaled)
⬆️ BP
Reduces mortality and morbidity in croup–> laryngotracheobronchitis
But
Not used in epiglottitis- can be deleterious.
Whats croup?
Laryngotracheobronchitis- inflammation of mucosa, increased secretions affecting airways
Odema- dangerous- subglottic area- trachea narrowing in young children.
Viral croup-95% , parainfluenza commonest, RSV, influenza.
6M-6Y, peak 2Y.
Autumn.
Sx worse at night, barking cough, coryza –> fever, harsh stridor, hoarsness.
Mild UAO- resection + stridor disappear at rest- managed at home
Oral dexamethasone, oral orednisolone + nebulised steroids (budesonide) reduce severity and duration and need for hospitalisation.
Severe:UAO
Nebulised epinephrine w/ oxygen by facemask transient impeovement.
Reccurent- atopy?
What happens in pseudomembranous croup? Bacterial tracheitis
Rare
Dangerous
Similar to severe viral croup - higher fever, appears toxic, thick airway obstruction + rapidly progressivle UAO
By S. Aureus
Tx- IV antibioticcs and intubation and ventilation if required.
Acute epiglotitis- disease framework
Life threatening emergency ⬆️ risk of resp obstructiom
H. Imfluenzae type b. Immunization»_space;99% reduction
Intense swelling of epiglottis + surrounding tissue assc w/ septicaemia
1-6Y but all age groups.
Onset:
Higher fever in all, toxic looking child, intensly painfull throat prevents speaking or swolling!! Saliva drouls down chin.
Soft inspiratory stridor + rapidly increasing respiratory difficulty over hours
Child sitting immobile, upright, with open mouth to optimise airway.
Suspected- urgent hospital admission
Child intubated under general anaesthetic.
How do you distinuish croup -V from epiglottitis?
Croup. Epiglottitis
Onset- over days. Over hours
Preciding
Coryza Yes. No
Cough. Severe, barking. Abscent or slight
Able to
Drink. Yes. No
Drooling
saliva. No. Yes
Appearance. Unwell. Toxic, very ill
Fever. 38.5
Stridor. Harsh, rasping. Soft, whispering
Voice, cry. Hoarse. Muffled, reluctant ro speak.
Whats pertussis?
Caused by Bordetella pertusis
Paroxysmal cough followed by inspiratory whoop and V
in infants- apnoea rather than whoop - potentially dangerous
Dx- culture of organism on perinasal swab,
Marked lymphocytosis on blood film !
Highly contagious resp infx
Endemic
After a week of coryza- child develops whooping cough , worse spasms of cough at night ,
During paroxysm - child goes red or blue in face and mucus flows from nose to mouth.
Susceptible- 15x10.9/L on FBC
Close contacts- erythromycin prophylaxis
Unvaccinated kid contacts should be vaccinated.
Vaccine- reduces risk of developing disease and reduces severity in those who have it. Does not guarantee full protection.
LRTIs- diseases?
Whatbare thebDDx of wheezing?
Obstruction of airways below thoracic outlet- usually more expiratory sounds
Classical sx- wheezing
DDx of wheezing
Common- asthma, (recurrent wheezing episodes, identifyiable triggers, typically over >6Y)
Broncholitis- 1st wheezing episode usually under
Disease framework of pneumonia
Etiology- infl of pulmonary tissue, assc w/ consolidation of alveolar spaces
PC-
Incidence⬆️ in 1st year, Viral infx commonest
Whats broncholitis? CF and inv?
LRTI that has wheezing and signs of resp distress
Epidimiology- Commonest LRTI in infants, affects about 50% of children in first 2Y of life , peak incidence 6M, winter + early spring.
⬆️ incidence of asthma in later life
Etiology:
RSV (>50%), parainfluenza, influenza, rhinovirus, adenovirus, M.pneimoniae (rare)
CF Prodrome of URTI w/ cough and fever Fedding difficulties, irritability Whezzing, crackles, resp distress, tachypnoea, tachycardia, retractions, poor air entry Sx peak at 3-4d
Invx
CXR- only in severe disease, poor response, to therapy, chronic episodes: air trapping, peribronchial thickening, atelectasis, increased linear markings
NP swab- direct detection of viral antigen (immunoflurescence)
WBC can be normal
