Wheezing child Flashcards Preview

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Flashcards in Wheezing child Deck (23):
1

acute onset: weak cough, wheezing after eating
inability to speak/cry
cyanosis, respiratory distress
vomiting, drooling, blood-streaked saliva
exam: unilateral wheezing, inspiratory stridor, ↓ or unequal BS
no chest rise on ventilation attempt
clutch neck with hands (universal choking sign)
common 6 mo-3yo

foreign body airway obstruction

2

treatment of foreign body obstruction

ventilation and head-tilt maneuver to open airway
if ventilation unsuccessful (no chest rise): Heimlich maneuver (subdiaphragmatic abdominal thrusts)
if unsuccessful after 1 min, call EMS and continue CPR
bronchoscopy
CXR may show radiopaque object or localized hyperinflation and/or atelectasis

3

etiology of acute wheezing

acute: asthma, viral bronchiolitis, FBAO
recurrent: bronchomalacia, vascular rings and slings, GERD, bonrchopulmonary dysplasia, CF

4

most common cause of acute wheezing if younger than 2 yo (peak: 1-3 mo), most common hospitalization if

bronchiolitis

5

initial (URI): rhinorrhea, nasal congestion, pharyngitis → low grade fever
2-5 days later: worsening rhinorrhea, cough, irritable, dyspnea, wheezing → poor PO intake, dehydration
exam: wheezing, fine crackles, prolonged expiratory phase, ↑ RR, increase WOB (nasal flaring, intercostal retraction, apnea)
other signs: hypo or hyperthermia, otitis media

bronchiolitis

6

diagnosis of bronchiolitis

presentation, age, time of year, physical exam
CXR only if uncertain or unusual: bronchial wall thickening, tiny nodules, linear opacities, atelectasis, patchy alveolar opacities, lobar consolidation
CBC: Normal
sputum culture if pneumonia or bacterial superinfection suspected
r/o bacterial pneumonia, sepsis, congestive heart failure

7

hospitalization for RSV if

respiratory distress

8

treatment of RSV

self-limited, can manage OP
if SpO2

9

singe best indicator of severity of bronchiolitis is:

low SpO2
good prognosis: good PO intake, > 2mo, SpO2 equal or > 94%

10

hx of bronchiolitis is risk factor for

developing asthma

11

most common cause of airway obstruction if 6 mo-6 years
leading cause of hospitalization if

croup

12

etiology of croup

viral infection causes inflammation of subglottic region of larynx

13

12 hr-3 days: rhinorrhea, low-grade fever
barking cough
hoarseness
stridor
respiratory distress worse at night, hypoxia in severe cases
confirmatory neck xray: "steeple sign" subglottic narrowing of tracheal lumen

croup

14

treatment of croup

based on severity of symptoms (Wesley croup score):
LOC
cyanosis
resting stridor
air entry
retractions
mild: single CS dose (↓ laryngeal edema) to prevent hospitalization
mod: epinephrine + single CS to prevent hospitalization
severe (cyanosis, ↓ LOC, severe stridor, severe retractions, toxic): hospitalization with steroids + nebulized epinephrine (adrenergic effect: constrict arterioles → ↑ fluid resorption, B2 effect: bronchial SM relaxation, brochodilation)
emergency: O2 (not humidified like bronchiolitis)

15

drugs to avoid if have croup

sedatives
opiates
expectorants
bronchodilators
antihistamines

16

bacterial infection of supraglottic tissue
rapidly progressive airway obstruction

epiglottitis

17

children

epiglottitis

18

treatment of epiglottitis: hospitalized since medical emergency

visualization to confirm inflamed epiglottis is done in OR
keep calm to prevent obstruction
antibiotics: oxacillin or nafcillin, cefazolin, clindamycin, ceftrizone, cefotaxime
ICU hospitalization with:
initial: supplemental O2 (blow-by O2)
acute resp distress: 100% O2 ventilation (bag-valve mask), intubate (ideally done in OR with GA)

19

2-4 yo child
fever, drooling, dysphagia, odynophagia, stridor, resp distress
exam: tender, enlarged cervical LAD, limited cervical spine ROM, stridor, wheezing
xray (diagnostic): bulging in posterior pharynx
extension of a pharyngeal infection, trauma, instrumentation, foreign body

retropharyngeal abscess

20

treatment of retropharyngeal abscess

cephalosporin or antistaph penicillin OR
I &D

21

infection of superior pole of tonsils
young teenager
fever, pharyngitis, muffled voice, drooling, trismus (spasm of jaw), neck pain
exam: enlarged tonsils + abscess, deviated uvula, cervical LAD
CT (diagnosis)
complications: obstruction, septicemia, aspiration, jugular vein thrombosis/thrombophlebitis, CA rupture, mediastinitis

peritonsillar abscess

22

treatment of peritonsillar abscess

ampicillin-sulbactam or clindamycin (pen allergic) for 14 days
I&D: first line or when antibiotics fail

23

disappearance of wheezing suggests

complete blockage of airway or imminent respiratory failure