CSE patho 4

what is the cause of CROUP?

primarily a viral infection most often caused by parainfluenza viruses or RSV transmitted by aerosol droplets

what si the pt past medcial history for CORPU?

recent cold that developed gradually into barking cough over 2-3 days more common in fall and winter

what is the cough of a pt with CROUP? physical appearance?

cough: barking, stridor, hoarse voice

physical appearance: cyanosis alter with some accessory msucle use, nasal flaring, rhinorrhea

what is the breath sounds and vital signs of a pt with CROUP?

breath sounds: diminished with inspiratory stridor

vital signs: increased HR, BP, low grade fever

what is seen on the lateral neck x ray for CROUP?

x-ray: haziness in the super glottic area, steeple, sign, pencil point, picket fence, hourglass narrowing of the upper airway

in mild CROUP cases what is the supportive care given?

• temp control- cool enviornment

• adequate hydration and humidification of inspired air

• monitor: vitals, degree of retractions and LOC

in mild CROUP what is other tx and management given?

• O2 therapy 30-40%

• cool aerosol mist (face mask)

• drug therapy

  • racemic epi

  • corticosteroids if not responsive o racemic epi

what is the criteria for intubation for pt with CROUP?

lethargic, exhausted

severe stridor at rest

diminished breath sounds

extreme accessory muscle usage

what tx is given to pt with severe CROUP?

• temp control- cool enviornement

• adequate hydration and humidification of inspired air

• transfer to ICU

• sedate to prevent inadvertent extubation

• place on t-piece or CPAP

what is the cause of epiglottitis?

bacterial infection caused by haemophilus influenza B gram negative bacteria transmitted by aerosol droplets

what is the past medical history of pt with epiglottitis? cough? physical appearance?

history: sudden onset within 6-8 hours

cough: muffled cough

appearance: 2-6 year old, pale or cyanotic, lifeless , drooling, hoarseness, dysphaiga, tongue thrust forward during inspiration muffled voice/ cry, jaw jutted forward

what is the resp pattern of a pt with epiglottitis? breath sounds? vitals?

resp. pattern: tachypnea, nasal flaring, substernal and intercostal retractions

breath sounds; diminished with inspiratory stridor

vitals: increased HR, BP, high grade fever

what shoudl you avid in pt with epiglotittis? what is the lateral neck x ray look like?

avoid unnecessary stimulation of the child

x-ray: haziness in teh supraglottic area “thumb sign”

what does the ABG look like for pt with epiglotittis? CBC?

ABG: acute alveolar hypertension with hypoxemia

CBC: elevated WBC

what management/ tx is done for pt with epiglottitis?

• immediate placement of ETT or trach is unable to intubate

• transfer to ICU

• sedate to prevent inadvertent extubation

• place on T piece or CPAP

• O2 therapy

• antibiotics

what is RSV/ bronchiolitis? what pt is at risk?

acute inflammation of the lower respiratory tract

at risk: children less than 1 years old, children with weakened immune system, and children with chronic respiratory or cardiac disease

what is teh past medical history of pt with RSV? general appearance

history: upper airway infection

appearance: tachypnea, apnea in severe cases, grunting, intercostal/ substernal retractions, and intermittent cough

what are the breath sounds of a pt with RSV? chest percussion?

breath sounds: wheeze, crackles, upper airway noise from secretions

percussion: hyperresonance in severe cases

what does the chest X-ray look like for RSV? pulmonary function?

X-ray: hyperinflation with area of consolidation or atelectasis

function: decreased flow rates (FEV1, FEF 25-75% and FEF 200-1200)

what special test are done for RSV?

detection of RSV antigen in washings of masopharynx or oropharynx via

• EIA

• RIDP

what is give to children at risk of developing RSV?

• prophylaxis with respigam

or

• palivizumab (synagis)

what at home tx is given for RSV?

humidifcation

oral decongestants

what tx is given for pt admitted into hospital with RSV?

• systemic hydration

• oxygen therapy

• bronchodilators to relieve wheezing

• airway clearance therapy

what is Tetralogy of Fallot? transposition of great vessels?

tetralogy: overriding aorta, pulmonary stenosis, ventricular septal defect and right ventricular hypertrophy

transposition: aorta and pulmonary artery are switched

what is the general appearance for pt with congenital heart defects? resp pattern? auscultation?

appearance: cyanosis

resp. pattern: tachycardia

auscultation: normal breath sounds, loud heart murmeur

what is teh chest x ray for tetrology of fallot? transposition of great vessles?

fallot: boot shaped

transposition: egg shaped

what is the most important test for congenital heart defects?

echocardiogram used to identify cardiac defects

what is the tx for pt with congenital heart defects?

• oxygen therapy

• mechanical ventilation for ventilatory failure

• postaglandins to maintain patent ductus arterious

• supportive care prior to surgical care of defect

what is IRDS? what is it caused by?

insufficient amount of surfactant leading to atelectasis and hypoxemia

caused by premature or high risk infants

what is the past medical history for IRDS? general appearance?

history: < 38 weeks, low APGAR, signs of resp. distress at birth or within a few hours after delivery, L/S ration < 2:1

appearance: cyanosis

what is the resp pattern of someone with IRDS? breath sounds

resp. pattern: tachypnea, possible apnea, intercostal retractions, nasal flaring, grunting

breath sounds: bronchial or harsh, fine crackles/ rales, expiratory grunting

what is the chest X-ray for a pt with IRDS? ABG?

X-ray: increased opacity, ground glass, air bronchograms

ABG: acute alveolar hyperventilation with hypoxemia

what do you do to correct the hypoxemia in IRDS pt?

• oxygen via oxyhood or nasal cannula

• CPAP (4-6)

• maintain PaO2 between 50-80 torr and SpO2 between 89-90%

what tx is given to pt with IRDS? how is surfactant given?

• maintain thermal environment

• recommend surfactant therapy

instilled into the ETT through a 5 Fr catheter

administered in 4 portions one at a time

catheter removed after each administration

change pt position to increase distribution

what should you do for neonatal resuscitation?

• provide warmth

• maintain airway patencey by extending the neck slightly

• clear airway of amniotic fluid or meconium

• stimulate by gently rubbing baby’s back, trunk or extremities

• evaluate respirations

when should oxygen be administered? what devices are used to admimnister?

as necessary

if newborn is breathing but there SpO2 is less then the target range start free flow oxygen at 30% with a blender and flow at 10

devices:

hold close to the newborns mouth and nose

• oxygen tubing

• face mask for a flow inflating resuscitation bag

• face mask from t- pieace resuscitator (neopuff)

what should SpO2 be at 1min? 2? 3? 4? 5? 10?

1= 60-65%

2=65-70%

3=70-75%

4=75-80%

5=80-85%

10= 85-95%

when should you initiate PPV?

• if newborn is gasping or apneic and if HR<100

• use enough inflation pressure to make the chest rise

• deliver breaths at RR of 40-60

when should you start chest compressions? what is the compression to ventilation ratio? what is the FiO2 set at?

• when HR remains less than 60 despite 30 sec of effective positive pressure ventilation

• compression to ventilation ratio: 3:1

• 90 compresstions and 30 ventilations for each minute

• FiO2 at 100%