Download paediatrics Respiratory system

T. Cymes
Stage 3 student doctor
University of Cambridge
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Examination
 tips
 differences from adults
 red flags
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Asthma
Bronchiolitis
Pneumonia
Cystic fibrosis
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Other diseases
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Get to their level!
Let young children play with your stethoscope
 Great toy!
 Lets them get used to it
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Let parents undress the child only when needed
Start with least invasive examination
Show on parents, toy etc
Auscultate early
Save percussion until the end
▪ Start on arm or knee – they get used to it!
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Position
 Infants – lying on couch
 Toddler – on parent's lap
 Pre-school – while at play
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Initial impression important
 ?unwell child
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Look for dysmorphic features
Percussion can be omitted
 Little information in infants
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Tachypnoea / tachycardia
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Accessory muscles
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Intercostal recessions
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Wheeze
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Harrison’s sulcus
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Stridor
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Cyanosis
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Grunting
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Nasal flaring
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Silent chest
Source: lumen.luc.edu
Source: quickbase.intuit.com
Source: gponline.com
Source: Wikipedia
Source: BMJ
Source: englishclass.jp
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Epidemiology
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Examination out of attack
 15% prevalence
 ± wheeze
 Associated with atopy
 Reduced PEFR
History
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Examination during attack
 Wheeze & cough
 Signs of respiratory distress
 Worse a night
 Hyperexpansion
 Ask about
 Ascultate
▪ Triggers
▪ Frequency
▪ Interval symtpoms
 Reduced PEFR
 SpO2
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Acute attack – O SHIT!
 Oxygen
 Salbutamol
 Hydrocortisone
 Ipratropium
 Theophylline
 ! – get help!
 Monitor SpO2 and PEFR
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Chronic management ladder
Mild
• SABA
≥3 week
Poor
control
No
response
Poor
control
Poor
control
• Inhaled steroids at
conventional dosage
• LABA
• Reasses
• Leukotriene antagonists
• Theophylline
•Maximise inhaled steroids
•Refer
•Oral steroids
•Immunosuppression /
immunomodulation
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By RSV
Epidemiology
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 CXR
 Nasopharyngeal aspirate
 Winter
 1-9 months old
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Symtpoms
 Initially coryza
 SOB
 Sharp dry cough
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Signs
 Tachypnoea
 Wheeze & crackles
 Hyperinflated
Investigations
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Management
 Humidified O2
 ± fluids
 ± parenteral
feeding
Source: Wikipedia
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History
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Often URTI
Cough
Poor feeding
“Unwell child”
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Management
 Usually at home
 Oxygen & anaelgesia as needed
Age
Pathogens
Empirical
antibiotics
Examination
Neonate
 Tachypnoea
 Nasal flare
 Chest indrawing
GBS
E. coli
Ampicillin +
gentamicin
> 5 years
old
Viral
Strep. pneumoniae
H. influenzae
B. pertussis
Ampicillin
Ceftriaxone
> 5 years
old
Strep. pneumoniae
H. influenzae
GAS
Mycoplasma
Amoxicillin
Erythromycin
Investigations
 CXR
 Nasopharyngeal aspirate
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Part of Guthrie test
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 Hyperinflated
 Wheeze
 Coarse crackles
Autosomal recessive
 1:2500 live births
 1:25 are carriers
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History
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Meconium ileus (10-20%)
Persistent cough
Recurrent/chronic chest infection
Bronciectasis in children
Malabsorption  failure to thrive
Male infertility
Signs
Management
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Monitor lung function
Prophylactic + rescue antibiotics
Physiotherapy
Bilateral lung transplant when end-stage
 Nutrtional
▪ Pancreatic enzyme supplements
▪ 150% healthy calorie intake
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Croup
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Acute epiglottitis
 Parainfluenza virus
 H. influenzae type b
 URTI  barking cough + stridor
 Very painful throat
 Improve over 24h
 Sits up with open mouth
 Symptomatic management
 Drooling
 ?Steroids
 DON’T examine throat
 Intubate, then:
▪ Blood culture
▪ Cefuroxime IV
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Whooping cough
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Acute otitis media
 B. pertussis
 RSV, pneumococci, Hib, GBS
 Coryza
 Earache in older children
 Coughing paroxysms
 Fever
▪ Inspiratory whoop
 Erythromycin
 Exclude via otoscopy in any ill
oddler
 Management
▪ Symptomatic
▪ amoxicillin