Term
|
Definition
| lower respiratory obstruction causes inspiratory sound |
|
|
Term
| why do kids wheeze more (5) |
|
Definition
small airways and increased total airway resistance (bronchoconstriction)
more easily occluded
poor cartiladgenous suport
ineffective cough |
|
|
Term
| what are 12 conditions that cause wheeze |
|
Definition
viral bronchiolitis
post-bronchiolitis wheeze syndrome
asthma
GERD
aspiration
laryngo-tracheo-broncho-malacia
airway compression: vascular ring, mediastinal mass
intrinsic lesions: foreign body, subglottic stenosis
cystic fibrosis
primary ciliary dyskinesia
bronchopulmonary displasia
bronchiolitis oliterations
immune deficiency |
|
|
Term
| define acute viral bronchiolitis |
|
Definition
| inflammation of the bronchioles causing airway obstruction |
|
|
Term
| what is the most common cause of acute viral bronchiolitis |
|
Definition
| RSV A and B (circulate together) in kids <5 |
|
|
Term
|
Definition
kids <2 (90% <1)
concern in immune compormised and elderly |
|
|
Term
| when is acute viral bronchiolitis most seen |
|
Definition
|
|
Term
| 4 morphological charactristics of RSV |
|
Definition
submucosal edema
epithelial sloughing
exudates and fibrin
mononuclear infiltration: CD4, macrophages, few PMN |
|
|
Term
| what, other than RSV, causes acute viral bronchiolitis |
|
Definition
strep pneumo
adenovirus
influenza
M. pneumo |
|
|
Term
|
Definition
chronic lung or heart disease
pulmonary hypertension
compormised airway
immune compormised
cystic fibrosis
premature baby <32 weeks
neuromuscular disease: cannot cough well |
|
|
Term
| why are premature babies more at risk for RSV |
|
Definition
underdeveloped immune system
low weight
altered airway |
|
|
Term
|
Definition
mostly on people with respiratory droplets
fomites
nosocomal spread is common (lives 6 hours on stethascope)
fluids from eyes and noes (some from mouth) |
|
|
Term
| how can RSV transmission be controlled |
|
Definition
|
|
Term
| what diseases does RSV cause |
|
Definition
pediatric bronchioltis
pediatric pneumonia |
|
|
Term
|
Definition
tachypenia
retractions
hyperinflation
wheeze
crackles |
|
|
Term
| explain the timeline of RSV |
|
Definition
incubation 2-8d
URI 2-3d - mild bronchiolitis
LRI for a week (viral shedding lasts 3-4 weeks) |
|
|
Term
| why is the transmission timeline os RSV so concerning |
|
Definition
| titer may only be visible for one week but viral shedding can last 3-4 weeks once we think the person is just fine |
|
|
Term
| what should you ask someone in the history when you think they might have RSV |
|
Definition
age, duration, severity
feeding, hydration
premature? BPD, CHD, CF, asthma?
smoking in home? day care? |
|
|
Term
| what is the main way to diagnose RSV |
|
Definition
| physical exam and history NOT TESTING |
|
|
Term
| what should be done/seen on a suspected RSV physical exam |
|
Definition
RR and distress evaluation
weight loss of gain check
wheezing, crackles
hypoxemia: tachycardia, restless, hypertensive
hypercarbia: flushing, bounding pulse, drowsiness
chest deformity, clubbing, edema, murmur, gallop, spleen check |
|
|
Term
| what tests should be run on a potential RSV patient |
|
Definition
pulse ox, CXR, CBC, culture
viral respiratory battery, bacterial respiratory culture
arterial blood gas if indicated |
|
|
Term
| what are the two main complications of RSV |
|
Definition
|
|
Term
| what is apena, why is it seen with RSV |
|
Definition
quick breathing
may be presentin symptom |
|
|
Term
| what is aspiration, why is it seen with RSV |
|
Definition
| nost is blocked and mom feeds leading to aspiration |
|
|
Term
|
Definition
apenia
aspiration
dehydration
respiratory failure
SIADH
asthma
UTI / infection
increased morbidity in developmental years |
|
|
Term
| what is the most common RSV treatment |
|
Definition
self limited in healthy kids
humidifier, nasal suction
monitoring for apenia, hypoxia, temp, hydration |
|
|
Term
| when should to admit someone with RSV (9) |
|
Definition
severe distress
O2 <92%
atelectasis (collapse) on CXR
poor feedind / dehydration
poor home status
premature
chronic heart or lung disease |
|
|
Term
|
Definition
breast feeding
avoid smoking
hand washing with alcohol rubs
palivizumab |
|
|
Term
| who should get palovizumab |
|
Definition
premature babies
congenital heart or lung disease
<6 mo in RSV season |
|
|
Term
| what are some drugs that can tx RSV and their prognosis |
|
Definition
bronchodilators and epi: limited efficacy unless previous wheeze
corticosteroids: little use unless very early in therapy
hypertonic saliene: makes mucous thinner (maybe baby is more comfy?) |
|
|
Term
|
Definition
turbulence in upper airway causing inspiratory sound
can be combined with expiratory sound from subepiglottic area which is a sign of respiratory failure |
|
|
Term
| what do you need to ask in a history when pt has stridor |
|
Definition
acute vs persistant
associate symptoms
aggrevating factors
association with feeding or change in position
history of airway insturmentation causing subglottic narrowing, asthma, GERD |
|
|
Term
| what is the first thing to do on a physical exam for stridor, what is second |
|
Definition
assess need for emergency airway intervention while keeping child calm and in mom's arms
external mass/hemangomia evaluation |
|
|
Term
| if kid needs emergency airway intervention what is the process |
|
Definition
dont do tests or lengthy exam keep child calm in moms arms and administer oxygen with racemic epinepherine
obtain CPR supplies, airway team, head to OR with baby in mom's arms
inhaled anasthesia, IV fluids, antibiotics, restraints, sedative
laryngoscopy, bronchoscopy, intubation for epiglottitis/bacterial tracheitis
return to peds ICU sedated |
|
|
Term
| what tests should be run on a pt with stridor |
|
Definition
AP and lateral neck and chest
barium esophaogram
direct laryngoscopy
bronchoscopy: rigid, flexible |
|
|
Term
| what infections cause upper respiratory obstruction (5) |
|
Definition
laryngotracheobronchitis (croup)
supraglottitis
bacterial tracheitis
peritonsillar and retropharyngeal abscess
diptheria |
|
|
Term
| what non infections cause upper respiratory obstruction (6) |
|
Definition
spasmodic croup
foreign body
allergic reaction
trauma and burns
hypocalcemia
laryngomalacia: floppy airway |
|
|
Term
|
Definition
| inflammation of larynx and eubglottis |
|
|
Term
|
Definition
|
|
Term
| what is the most common cause of croup, what is next |
|
Definition
parainfluenza most common
viruses, mycoplasma |
|
|
Term
| why dosent everyone with parainfluenza get croup |
|
Definition
| genetic factors, those with croup make less histamine/IgE |
|
|
Term
| why do some people get reoccuring croup |
|
Definition
| narrow airway, atopy, GERD, immune response |
|
|
Term
| what are 2 risk factors of croup |
|
Definition
| intubation and papillomas cause narrowing and scaring |
|
|
Term
| what is the timeline of croup |
|
Definition
prodrome 1-7d with runny nose and cough
lasts 3-5 days |
|
|
Term
|
Definition
barky cough (common)
inspiratory stridor
rapid breathing
unable to feed
unalbe to lay down
hoarsness |
|
|
Term
|
Definition
| subglottic stenosis in intubated patient |
|
|
Term
|
Definition
|
|
Term
| why send someone to hospital for croup |
|
Definition
high clinical score, poor response to therapy
need O2
poor hydration
toxic
<6 mo
poor family situation
reoccuring ER visits |
|
|
Term
| what medications can be used to tx croup, how must they be administered |
|
Definition
dexamethasone
racemic epi: shrinks mucosal edema but in a few hours it can come back worse, must monitor for 4 hours |
|
|
Term
|
Definition
|
|
Term
|
Definition
rapid onset of 4-12 hours
lasts 3-4 days |
|
|
Term
|
Definition
stroidor, aphonia, dysphagia
drooling
fever, toxicity, anxiety
unable to lay down
plum sign on lateral x-ray |
|
|
Term
| complications of epiglottitis |
|
Definition
|
|
Term
|
Definition
dont examine baby! could close airway
secure airway, restrain, sedate
antibiotics
extubation after air leak evident |
|
|
Term
| causes of bacterial tracheitis |
|
Definition
staph
viral illness allowing bacteria in
often percipitated by influenza |
|
|
Term
| timeline of bacterial tracheitis |
|
Definition
prodrome of 3 days (at 10h looks like croup)
lasts 20 days |
|
|
Term
| symptoms of bacterial tracheitis |
|
Definition
| cough, sore throat, fever, toxic, horase |
|
|
Term
| complications of bacterial tracheitis |
|
Definition
| tracheal stenosis / tracheostomy |
|
|
Term
|
Definition
bronchoscopy gives diagnosis
intubation, sedation, restraints
antibiotics |
|
|
Term
|
Definition
|
|
Term
|
Definition
nightime sudden onset often due to cold air
sudden resolution
brassy cough
no prodrome or fever
history of atopy or croup |
|
|
Term
|
Definition
racemic epi
humidified O2
steroids and intubation - rare |
|
|
