Wheeze Flashcards
Define wheeze
Prolonged musical note heard mainly on expiration (may be referred to as rhonchus on auscultation) due obstruction of the LOWER airways
What are the causes of wheeze
partial obstruction of the intrathoracic pathways, as a result of both intrinsic and extrinsic factors
Viral induced wheeze
Exacerbation of asthma
Bronchiolitis
Croup
Epiglottitis
Foreign inhaled object
Anaphylaxis
“Happy wheeze” - persistent wheeze that does not affect eating, temperament and growth
What should be looked for on examination for children with a wheeze
Height and weight
- Poor growth: cystic fibrosis
- Growth failure: severe asthma
General
- ? Clubbing, barrel chest (chronic suppurative lung disease in asthma)
Respiratory
- ? Resp. distress
- ?hyper-resonance and dullness on percussion
- Widespread crepitations = infection, particularly bronchiolitis
What are the signs of respiratory distress in children
Shortness of breath (Dyspnoea)
Tachypnoea
Intercostal/subcostal recessions
Tracheal trug
Use of accessory muscles
Nasal flaring
Inability to talk
Cyanosis
Confusion
Restlessness
Drowsiness
What are the signs of foreign body in the airway on examination and on CXR
May be preceded by choking episode
unilateral wheeze
Focal dullness with increased resonance
Crepitations
Focal reduced air entry
CXR: Segmental collapse or emphysema
What is viral induced wheeze and what is it caused by
Wheeze that only comes on with infection
Associated with RTIs in 6 month-5yo
What is the management for viral induced wheeze
Usually self-limiting
Advise:
Fever settles after 3-7 days
Cough resolves within 3 weeks
15% of children who wheeze younger than 5 years of age have asthma, and continue to wheeze >5yo
What are the signs of pneumonia on exam
General: signs of resp. distress
Obs: fever, tachypnoea, tachycardia
Resp: absent breath sounds with dull percussion
What is the management for community acquired pneumonia
Antibiotics: amoxicillin for 5 days
+ follow up
