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Transcript
CHILDRENS COUGH. ACUTE PNEUMONIA Lecture course for students of six-year Associate professor Abdusagatova Sh.Sh. Cough This is a protective reaction of organism, helps to restore breathing passages CHILDREN COUGH Can occur in many diseases, but most often it is a symptom of acute respiratory infection and develops within 48 hours of onset. The main causes of cough Respiratory infections of the upper and lower respiratory tract Bronchial asthma Foreign body aspiration Chronic bronchopulmonary disease Cystic fibrosis Whooping cough Tuberculosis Other (swelling, pulmonary edema, etc.) Causes of cough Respiratory infections of the upper respiratory tract: Rhinitis, rhinosinusitis Syndrome of postnasal streaks Pharyngitis Adenoids grade 2-3 Acute constrictive laryngitis (croup) Causes of cough Lower respiratory tract infections: Tracheitis Bronchitis Pneumonia The main causes of cough Diseases of the cardiovascular system: -heart failure -heart disease -pericarditis The main causes of cough Diseases of the gastrointestinal tract: - gastroesophageal reflux -hiatal hernia The main causes of cough Diffuse connective tissue disease Medical reasons ("kapotenov" cough) Iatrogenic causes (postintubatsionny syndrome) Smoking (including passive) The pathogenesis of cough One of the main factors is a violation of mucociliary clearance This is due to excess formation and / or increased viscosity of bronchial secretions The pathogenesis of cough Stagnation of the bronchial contents leads to disruption of ventilation-protective function of the lungs, infection - the development of endobronchial or bronchopulmonary inflammation The pathogenesis of cough Produced by viscous secret may cause bronchial obstruction due to accumulation of mucus in the respiratory tract The pathogenesis of cough In severe cases of violations of air accompanied by the development of atelectasis Mucociliary transport - Is a critical mechanism to ensure sanitation of the respiratory tract. Its speed of a healthy person 4 - 20 mm / min Normally a day transported from 10 to 100 ml of bronchial secretions Bronchial secretion Normally has a bactericidal effect The pathology observed compensatory increase of mucuse . Increases the viscosity of sputum Increased adhesion of pathogens to mucosal Favorable conditions for the reproduction of microorganisms Reduced the bactericidal properties of mucus Infectious agents and toxins have adverse effects on the mucous The drainage function of the bronchial tree Violations can result in her not only to vent violations, but also reduce the local immunological respiratory protection at high risk of a protracted course of the inflammatory process and contribute to its perpetuation. Inflammation of the respiratory tract is a major pathogenic element in the development of mechanisms of bronchial obstruction (bronchospasm, hypersecretion of viscous mucus, swelling of the bronchial mucosa) Children acute pneumonia Children Cough Two of the three children attending the clinic to see a doctor - it is children, with complaints of cough Acute Pneumonia -acute infectious disease of lung parenchyma, diagnosed by respiratory distress syndrome and physical data, as well as infiltrative or focal changes on chest radiograph. Statistics The average incidence of children aged 0 to 15 years is 7.1 per 1000 children per year Up to 1 year - 11.4 per 1,000 1-4 years - 13.9 per 1,000 5 - 15 years - 3.7 per 1000 Другие заболевания 24,4% Травмы и Отравления 9,7% Инфекционные заболевания 5,5% Врожденные Аномалии 7,5% Болезни Органов Дыхания 46,4% Features breathing of children Short airways Weak expression of epithelium lining the respiratory tract, track their vulnerability The horizontal position of the ribs, the low mobility of the chest High standing of the diaphragm Dimensions of light relatively larger than the size of the chest Incompleteness of bronchopulmonary apparatus Factors predisposing to pneumonia From an unfavorable social environment With variations in health status (rickets, malnutrition, anemia, etc.) With a family history (on bronchopulmonary and allergic diseases) With perinatal disorders With congenital malformations of the respiratory and cardiac Since hereditary pathology On the anomalies of the Constitution Chronic foci of infection and hypothermia The main functions of the lungs Respiratory Protective and adaptive Surfactant-producing The protective function of the lungs Upper sections of the mucociliary system Average departments - BALT (bronhoassotiation lymphoid tissue) Lower sections, alveolar macrophages, serum immunoglobulin A Respiratory cycle Phase of respiratory The diffusion of gases through the alveolarcapillary membrane lung Transport of oxygen in the blood to tissues Oxygen permeability through the membrane of the capillaries in the mainstream of the microcirculation Tissue (cellular) respiration Surfactant-producing lung function Prevents atelectasis on expiratory Supports normal permeability aerogematic barrier of the lungs Creates an optimum level of filtration pressure in the pulmonary microcirculation Prevents edema pulmonary epithelium and vascular endothelium Plays the role of antibodies to create an immune barrier in the lower regions of the lung tissue The etiology of pneumonia Pneumococci (65-85%) Gold stafillokokk Haemophilus influenzae Gram-negative flora The etiology of pneumonia Stafilococcus Klebsiella Pseudomonas aeruginosa The etiology of pneumonia of infants Viruses, mycoplasma (antenatal pneumonia ) colon bacillus Stafillococcus Klebsiella Proteus enterobacteria Blue pus bacillus pathogenic viruses pnevmotsisty The pathogenesis of P. Paths of infection The mechanism of NAM Genesis of the formation of metabolic and functional changes in organs and systems Paths of infection Bronchiogenic Hematogenous Lymphogenous Forms DS Ventilation. Diffusion Perfusion-Distribution Restrictive Pneumonia in a child is not a local disease, the development of pneumonia is accompanied by involvement in the process of not only metabolic but also in many other organs. Metabolic and functional impairment in OP Water deficit (shortness of breath, fever) Gipernatremiya, decreased urine output, increased ADH violation of CBS DIC Increased proteolytic activity Metabolic changes in the myocardium Increased blood pressure Violation of liver detoxification Renal impairment bowel dysfunction Classification of acute pneumonia In the form: lobular segmental lobar interstitial Classification of the AP in accordance with the severity of uncomplicated complications: NAM toxemia Classification of AP Adrift Acute (up to 3 months) Prolonged (more than 3 months) Mycoplasma pneumonia Can develop at any age Incubus. Period 1-3 weeks Start gradually Catarrhal conditions, fever Frequent debilitating cough up to 3 weeks. NAM expressed Physical data clearly X-ray: interstitial changes Treatment: macrolides are effective Pneumocystis pneumonia More common in premature infants, those receiving corticosteroids, cytotoxic drugs The incubation period is 2-3 weeks. Start slow, the symptoms of intoxication Painful cough with foam from the mouth In sputum, pnevmotsisty In the lungs, Physical data scarce DN grade 2-3 X-ray "padded easy" Stafillokok pneumonia More often in children 1 year of age fever toxemia Hepato-splenomegaly and diarrhea Krepitiruschie crackles in the lungs Pulmonary and extrapulmonary complications Anemia, leukocytosis Klebsiellez pneumonia Gram-rod Hospital infection acute onset intoxication In the lungs, necrotic and hemorrhagic changes, "creeping pneumonia" Abscesses, pneumoempyema Metastases, sepsis Chlamydial pneumonia More often in children younger than 6 months. Start gradually Catarrhal conditions, conjunctivitis, vaginitis dyspnea Kryahtyaschee breath cough pertussoid In the lungs, wheezing krepitiruyuschie during prolonged Virus pneumonia More often the exception than the rule Observed during an influenza outbreak hemorrhagic pneumonia Fungal pneumonia In protracted infections in children with eating disorders, digestive diseases, immune defects Cough with expectoration of gelatinous Anorexia, fever, sweats Heavy In sputum - fungi Yeast, lactic dermatitis The effect of antifungal drugs Deterioration in the background of antibiotic therapy Criteria for pneumonia Respiratory complaints The syndrome of intoxication Respiratory distress syndrome Local changes in lung Infiltrates and patchy shadows on chest radiograph Rapid breathing (WHO criteria) 60 Up to 2 months or more / min 12.2 months - 50 or more 1 - 5 years - 40 or more / min Complications of pneumonia Bulla abscesses pyothorax pneumothorax mediastinal emphysema pericarditis osteomyelitis sepsis Treatment of pneumonia Provision of urgent measures Treatment in the somatic hospital or ambulatory on a "hospital at home" Follow-up care in the office of Rehabilitation Clinical supervision for 6-12 months. Treatment of pneumonia causal treatment -antibiotics immunoglobulinpathogenetic therapy NAM-fighting -fight against cardiovascular disorders -detoxification physiotherapy stimulation therapy therapeutic exercise Indications for hospitalization Severe manifestations or complications Focal and confluent pneumonia prolonged duration Pneumonia in disadvantaged background (anemia, dystrophy, premature birth, etc.) Treatment failure within 24-36 hours Hospital at home lack of toxicity The absence of respiratory distress The absence of cardiovascular dysfunction Antibacterial therapy Up to 6 months: first fell ill - ampicillin, oxacillin, ampioks Re - cephalosporins, aminoglycosides Older than 6 months: ill the first time: penicillin Re-cephalosporins, aminoglycosides Urgent actions correction of hyperthermia correction NAM Normalization of pulmonary and peripheral microcirculation stabilization of the surfactant Correction of hyperthermia Cooling compress on my head Acetic alcohol rubbing of the skin Gipopiretiki: analgin, Panadol, Paracetamol, etc. Antispasmodics: No-Spa, papaverine, aminophylline, komplamin Neurovegetative blockers: droperidol, pipolfen Correction of the NAM and tissue hypoxia elevated position aeration Chamber Removing mucus from the respiratory tract Oxygen The elimination of hypokalemia and paresis of the intestine Tissue oxidants: riboflavin, cocarboxylase, cytochrome C, nicotinamide Correction of the pulmonary microcirculation and bronchial patency Antispasmodics: aminophylline, no-spa, papaverine, komplamin. Antiplatelet: chimes, trental B \ IV infusion: glucose, Lasix glucocorticoids Protease inhibitors: contrycal Correction of surfactantproducing lung function Dimefosfon (50 mg \ kg \ day) Essentiale (w / w, 0.3 ml / kg / day) Tocopherol (10mg/sut) Glycerol (mixed to spray) Ambroxol, Bromhexine GVEK (glucose, vit.S, cocarboxylase, cytochrome C) Treatment of children cough - Improving the drainage function of bronchi -restoration of adequate mucociliary clearance -anti-inflammatory therapy bronchodilator therapy Treatment of children cough The need to suppress cough, using real antitussive drugs in children are rare, their application to the pathophysiology of positions is not justified. Treatment of children cough in Effective antitussive therapy should not be to suppress cough, and his gain, subject to the transfer of dry cough in the productive. Improving the drainage function of bronchus - Active oral rehydration - The use of expectorants and mucolytic agents - massage - postural drainage - breathing exercises Means stimulating expectoration Reflexively acting drugs: Thermopsis, alteyka, licorice, terpingidrat, essential oils, etc. Drugs resorptive action: Potassium iodide, ammonium chloride, sodium bicarbonate, etc. Means stimulating expectoration (deficiencies) Can significantly increase the volume of bronchial secretions, which can lead to significant disruption of drainage of lung function, especially in young children, and reinfection Mucolytic drugs is optimal for the treatment of respiratory diseases in children. Bromhexine Ambroxol acetylcysteine Mesnil proteolytic enzymes Proteolytic enzymes Trypsin, chymotrypsin, RNA-ase Reduce the viscosity and elasticity of sputum, have edematous and anti-inflammatory action. Practically not used in pulmonology Mucolytic drugs Acecylsysteine reduces the viscosity of mucus, contributes to liquefaction of pus. Indications: acute, recurrent and chronic diseases of the respiratory tract, accompanied by the formation of viscous mucus. Mucolytic drugs Bromhexine-has mucolytic, mukokineticheskim and expectorant action. Indications: acute and chronic bronchitis, acute pneumonia, chronic bronchial disease. Mucolytic drugs Ambroxol-mucolytics new generation is a metabolite of bromgeksina has a more pronounced expectorant effect, affects the synthesis of bronchial secretions, liquefies phlegm and increases content of surfactant in the lungs does not cause bronchial obstruction, has anti-inflammatory and immunomodulatory effects. Treatment of children cough When the complex treatment of respiratory diseases, accompanied by a cough, mucolytic agents are preferably used with multiple dosage forms. tablets syrups capsules Solutions for oral inhaled form Bronchodilator therapy Salbutamol (betta2-agonists) Atrovent (anticholinergic drugs) Aminophylline (theophylline short-acting) Anti-inflammatory therapy NSAIDs antibiotics glucocorticoids fenspiride Thank you for your attention!