Respiratory Pediatrics
Topics Covered: - Epiglottitis
- Croup
- Bronchiolitis
- Foreign Body Aspiration
- Vascular Ring
- Pneumonia
Pre-reading Quiz:
1. Stridor is heard during ________ (inspiration/expiration), whereas wheezing is heard during ________ (inspiration/expiration).
2. Treatment of ____________ is nebulized racemic epinephrine + dexamethasone.
3. CXR for __________ will show unilateral hyperinflation +/- tracheal deviation to the opposite side.
Epiglottitis
What: bacterial infection of epiglottis w/ Hib, GAS, S. pneumo, S. Aureus
Why: hematogenous spread, unvaccinated (Hib)
Treatment: Ceftriaxone + Vancomycin, Endotracheal intubation
Buzzwords
tripod positioning
drooling, distress, dysphagia
Croup (Laryngotracheal bronchitis)
What: Parainfluenza virus >> RSV
Why: Hemagluttinin permits viral entry, Neuramidinase permits spread.
Sx: Prodromal phase w/ rhinitis/congestion, then cough in late evening
Treatment:
Nebulized Racemic epinephrine
Dexamethasone
Humidified air
Heliox decreases work of breathing
Buzzwords:
Barky cough worse at night
Inspiratory stridor
Bronchiolitis
What: RSV in patient less than 2 years old
Why: viral infection and inflammation of bronchioles
Sx: Prodrome phase w/ rhinitis/congestion, then cough/wheezing/crackles and respiratory distress
Treatment:
Nasal suctioning
Supplemental oxygen
HFNC, CPAP
Albuterol/epinephrine, Corticosteroids if severe
Palivizumab monthly during RSV season for first year of life if (premature <29 weeks, heart/lung disease, immunocompromised)
Buzzwords
URTI > Respiratory distress
Foreign Body aspiration
What: acute onset SOB due to foreign body in airway
Treatment:
Rigid bronchoscopy
Buzzwords
Sudden onset SOB
Hyperinflation + mediastinal shift
Decreased breath sounds
Vascular Ring
What: congenital aberrant branch of aorta encircling esophagus/trachea
Sx: Inspiratory and Expiratory stridor w/ history of noisy breathing since birth OR dysphagia to solids
Dx: CTA
Buzzwords
Biphasic stridor
Worsens with crying/feeding
Improves w/ neck extension
Pre-reading Quiz Answers:
1. Stridor is heard during ________ (inspiration/expiration), whereas wheezing is heard during ________ (inspiration/expiration).
2. Treatment of _Croup_ is nebulized racemic epinephrine + dexamethasone.
3. CXR for ___Foreign body aspiration__ will show unilateral hyperinflation +/- tracheal deviation to the opposite side.