Docstoc
EXCLUSIVE OFFER FOR DOCSTOC USERS
Try the all-new QuickBooks Online for FREE.  No credit card required.

Treatments of croup most afebrile children with spasmodic croup

Document Sample
Treatments of croup most afebrile children with spasmodic croup Powered By Docstoc
					Treatments of croup :---
  most afebrile children with spasmodic croup & mild ALTB can
usually be safely effectively managed at home .

 Treatments of underlying & often unsuspected G.E.R.
 may prevent spasmodic croup .
 Treatment at home by :---
    1-steam from a shower or bath in a close bath
 room.      Or
    2-steam from a vaporize or
    3- cold steam from a nebulizer .
  this will result in terminating in acute laryngial spasm
 & respiratory distress within minutes ( same effect by
 cold night air )
Also can use IPECAC to induce vomiting .
In hypoxic infant , given O2 of less than 100% saturated with H2O
vapor resulting in mucosal cooling leading vaso constriction & decrease
edema
Treatments of patients at hospital :-- •
     indication of admission :-- •
            1- highly or suspected epiglotitis 2- progressive stridor •
            3- sever stridor at birth         4- sign of resp. distress like •
              hypoxia , irritable , cynosis , sever pallor , depresed        •
               sensorium . •
For patients who admitted :--- •
    1- chart observation ( PR ,RR ). •
    2- parenteral fluid . •
    3- sedation is C.I ( because of restless is used as clinical indices •
       of severity of obstruction & need for tracheostomy or •
endotracheal intubation ) .
    4-children should be kept calm as possible to reduce resp. effort •
   5-O2 to alleviate hypoxia ( humidified O2 ) •
   6- brocho-dilator & expectorant are not helpful & A.B. is not indicated •
   7-Racemic epinphrine ( o.25 -0.75 ml in 3 ml normal saline can be used    •
Or used L-epinpherine ( 5 ml of 1:1000 solution ) is equally effective as
Racemic epinpherine .
Nebulized epinpherine should still be used cautiously in patient with

Tachycardia or heart condition like TOF, ventricular outlet •
obstruction .
   8- cortico steriod to reduce inflamatory edema & prevent •
destruced celiated epithilial ( aral dexamethazone 0.6 mglKg as
Single dose & may be 0.15mglkg may be just effective . •
 I.M decadron & nebulized budesonide have an equally effective •
   9- tracheostomy in sever cases with progressive stridor & cynosis. •
Indication of laryngoscope in croup :-- •
    1-very young of less than 4 month of age . •
    2- if symptom continue of more than 6 wk •
    this is to exclude sub-glotic stenosis or hemangioma. •
                           --3   •
Bacterial trachitis ;---
  is acute bacterial infection of trachea which able to obstruct air way
age of incidence of less than 3 years but in more recent cases , the

Mean age has been between 5& 7 years •
  causes by staph. Aureus (most common ) but PIV type 1 & H •
influenza , moraxalla catarrhalis & anarobic organism also been
implicated .
Usually follow viral resp. infection especially croup . •
ClF :--- •
      1- history of croup, followed by high fever , toxic associated •
        respiratory distress or may occur few days after improvement .     •
      2- patients lie flat , not drool , no dysphagia . •
      3- not respond to general treatment of croup . •
    intubation & tracheostomy is usually required ( but in more recent     •
    series , only 50-60 % of patients required intubation ) •
                             --4-- •
Pathology :--
    1- mucosal swelling at level of cricoid cartilage .
    2- thick copious , purulent secretion .

Diagnosis :-- •
     1- ClF     2- WBC leucocytosis with band form •
     3- X-ray is not needed , &may show classical feature pseudo •
        membrane detachment in the larynx . •
     4- laryngoscopy shows purulant material bellow cord . •
Treatment :-- •
  1- supporting :- O2 therapy , I.V fluid , intubation in sever cases •
  2- specific therapy by A .B ( anti staph ) •
CX :--- •
   1- resp. obstruction leading to resp. arrest •
   2- infection go down to parenchymal or bronchiol leading to pneu. •
   3- toxic shock syndrome •
Prognosis :- become afebrial patient within 2-3 days but may be prolonged   •
Hospitalization may be nesessory ( mean duration is 12 days ) •
                          ---5-- •
DD :-- of wheezing :---
     1- infection :- bronchiolitis , pneumonia .
     2- asthma

      3-anotomical abnormalities like :- A– central air way like •
             malasia of larynx , trachea, bronchi . •
             B-extrinsic air way anomalies by compression like •
vascular ring , mediastinal LAB , F.B in esophagus .
             C- intrinsic air way anomalies like hemangioma , cyst ,   •
               sequestration , F.B, CHD( LF to Rt shunt ) . •
         4- cystic fibrosis , bronchioactasis . •
         5- aspiration pneumonia , G.E.R •
         6- H.F 7- interstitial lung disease like bronchiolitis •
obliterance       8- anaphylaxis .
                            --6-- •
Bronchiolitis :---
   is common dis. Of LRTI of infant , is resulting from infla.
   Obst. Of small air way , characterized by wheezing .

occur in Ist year of life with peak incidence of 6 month , Its incidence •
 is highest in the winter & early spring .
     illness occurs sporadically & epidemically . •
Etiology :-- •
           is viral in origin in more than 50% by RSV. •
         is more common in male infant ( 3-6 month) who not breast •
fed infant , lived in crowded condition .
        also other member of family is ill . •
Pathophysiology :--- •
       0n overhead •
                          ---7--- •
   ClF :-- 1- usually other member of family were ill by viral infection .
   2-usually proceeded by URTI of few days before onset of resp. distress




    3-low grade fever 38.5—39c & other systemic manifestations like •
vomiting & diarrhea are usually absent.
    Apnea more prominent than wheezing in early course of dis. In •
   very young infant of less than 2 month of age or former premature infant   •
.
On Examination :- -- •
     1- resp. distress which variable from mild to sever . •
     2- in sever distress with sever hypoxia lead to convulsion & •
       dehydration due to insensible water loss . •
  Diagnosis :---- •
            1- ClF        •
            2- X-ray finding ( hyper inflation of chest , scattered area •
               of consolidation •
           3- WBC & diffrential count are usually normal . •
                         --8-- •
DD :-- 1-asthma       2- bronchopneumonia 3- F.B aspira.
       4- cong. H.F 5- poisoning 6- pertusis
       7- cystic fibrosis

Note :-- 50% of sever bronchiolitis may going to asthma •
Course :-- most critical period is 2-3 days after onset of cough & •
           dyspnea. & then improvement occurs rapidly & recovery •
          is completely within several days ( 10-14 days ) •
Death rate :-- is about 1—4% ( higher figures associated with higher •
              risk groups ) , caused by :--- •
                 1- prolong apneic spell •
                 2- sever uncompansated resp. acidosis •
                 3- profound dehydration •
Infant are more liable to morbidity & mortality if associated :--- •
   1-CHD       2- BPD 3-Cystic fibrosis 4- immune def. dis. •
H.F is rare Cx except if underlying heart dis. •
                        ---9--- •
Infant with bronchiolitis who developed asthma , are more likely to
 have :-- 1-family history of asthma & allergy
          2-prolong acute episode of bronchiolitis
          3- exposure to cigarette smoking

Treatment of bronchiolitis :-- •
    depend on severity of illness :-- •
   most children have mild illness & can be managed at home with •
   supporting measures . •
  5% of patients needs hospital admission :----indication of •
admission :---- 1-younger patients of less than 6 months .
                 2-moderate to marked resp. distress ( sleeping R.T •
                   of more than 50-60 breath l minutes or higher) •
                3- hypoxemia ( po2 of less than 50-60 mmHg ) or •
                    o2 saturation of less than 92% on room air •
                4- episode of apnea •
                5- inability to tolerate oral feeding •
               6-lack of appropriate care at home •
(children with CHD, BPD , NMD, immune def. ---- increasing risk of •
Supporting measures :--
     1- adequate fluid to maintain normal hydration
    2- antipyretic for febrile patients

     3- humidified o2 in sufficient concentration to maintain pao2 •
         70-90 mmHg & o2 saturation of more than 92% •
     4- broncho-dilator like B-agonist produce short term •
         improvement in clinical feature . •
        nebulized epinpherine may more effective than B-agonist. •
        cortico-steriod are often negative •
Specific therapy :-- •
       1- ribavirine is antiviral agent administered by aerosol has •
          been used for infant with CHD or chronic lung dis. •
       2- no support for RSV immune globuline administered •
          during acute episode of RSV . •
                          ---11-- •
Bronchiolitis obliterane :--
   caused by adeno virus , measles , pertusis , in which ,there is
     damage of bronchiol & smaller air with attempt repaired by granulation
tissue that obstruct the air way , evantually obliterate of lumen with nodular

Masses of granulation & fibrosis . •
ClF :-- gradual progressive resp. distress •
  X-ray :- ranged from normal to a pattern suggest of milliary T.B •
Bronchography --- :-obstruct of bronchus •
No specific therapy •
Congenital lobar emphysema :--- •
  is overinflation of one lobe ( most often left upper lobe ), which •
  produced resp. distress because of surrounding lung tissue •
become compressed leading to shifting mediastinum
Treatment by lobectomy may be required if resp. distress is sever or •
   progressive .                ---12--- •
                        thank you •

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:29
posted:11/14/2011
language:English
pages:12