Peds T2 ch 21

RSV season

winter & spring

myocoplasmal infection

> 5 yrs experience increase

common in fall & early winter

asthmatic bronchitis

freq in cold weather

resp infection s/s

fever

anorexia, V, diarrhea, abd pain

cough, sore throat, nasal blockage, discharge

wheezing, stridor, grunting, hoarse, crackles

≤ 2 months RR abnormalities 

> 60 respirations / min

2 - 12 months RR abnormalities 

> 50 respirations / min

1 - 5 yrs RR abnormalities 

> 40 respirations / min

5 - 12 yrs RR abnormalities 

> 30 respirations / min

≥ 12 yrs RR abnormalities 

20 respirations / min

stridor

high pitched sound d/t turbulent flow in upper airway or partial airway obstruction

inspiratory, expiratory, or both

wheezing 

high pitched whistling sound during breathing

d/t air moving through tight airways like in asthma

common on exhalation

retractions

inward movement of the muscles between ribs d /t reduced pressure in chest cavity

can be sign o of airway obstruction

grunting

↑ en expiratory pressure to prolong period of oxygen & carbon dioxide exchange

can be sign of

• acute pneumonia

• pleura involvement

• pulmonary edema

• RDS

BAD

agonal respirations

shallow, slow (3 - 4 bbm), irregular inspiration followed by irregular pauses

d/t cerebral ischemia & extreme hypoxia or anoxia

cyanpsis

late sign respiratory problem

lvl of conciousness

may indicate hypoxia

upper resp infection

nasopharyngitis

pharyngitis

tonsillitis

mononucleosis

influenza

otitis media

acute viral nasopharyngitis

common cold

d/t various viruses

• RSV, rhinovirus, adenovirus, influenza, parainfluenza viruses

fever - varies w/ age (3 month - 3 yrs)

tx usually @ home

acute infectious pharyngitis & tonsillitis

d/t

• viral or bacterial (strep)

s/s

• difficulty swallowing & breathing

• enlarged tonsils

• sore throat

• fever

tx

• viral - tx symptoms

• bacterial - culture, PCN, azithromycin

(acute) otitis media

most common early childhood disease (0 - 24 months)

s/s

• otoscope exam - purulent discolour w/ bulging

• pain, pulling @ ears

• discharge if ruptured

croup

viral origin

d/t

• hoarseness

• ‘barking’ / ‘seal like’ cough

• inspiratory stridor

• varying degrees of resp distress

• affect larynx, trachea, & bronchi

acute apiglottitis

EMERGENCY

bacterial in nature - H. influenzae B

most common 2 - 5 yrs

s/s

• sore throat, dysphasia, muffled voice

• pain

• tripod position, drooling, retractions

• high fever, toxic appearance

• inspiratory stridor, mild hypoxia, distress, agitation

tx

• stand by intubation / trache - ICU

• steroids, antibiotics

• ↓ stress

• DONT PUT ANYTHING NEAR THROAT

acute ltb / croup

laryngotracheobronchitis

most common of croup syndromes

usually < 5 yrs affected, preceded by a URI, slowly progressive

d/t

• RSV, parainfluenza virus, mycoplasma pneumonia, influenza A & B

s/s

• inspiratory stridor, suprasternal retractions

• barking / seal like cough

• ↑ resp distress & hypoxia

• may progress to resp acidosis, failure, & death

lower resp infections

bronchitis

RSV bronchiolitis

pneumonia

bronchitis

AKA tracheobronchitis

inflam of large airways (trachea & bronchi)

usually viral

s/s

• dry, hacking cough - worsens @ night, productive in 2 - 3 days

tx is symptomatic (humidity, antipyretics, analgesics)