Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

Assessment _amp; Management of Acute Paediatric Respiratory Problems

VIEWS: 0 PAGES: 43

									 Assessment & Management of
Acute Upper Airway Obstruction
         in Children
            Differential Diagnosis:
        Acute Upper Airways Obstruction


Croup:

• Viral Laryngotracheobronchitis (very common)
• Recurrent or spasmodic croup (common)
• Bacterial tracheitis (rare)
               Differential Diagnosis:
           Acute Upper Airways Obstruction
Rare Causes:
•   Epiglottis
•   Inhalation of smoke and hot air in fires
•   Trauma to the throat
•   Retropharyngeal abscess
•   Laryngeal foreign body
•   Angioedema
•   Infectious mononucleosis
•   Measles
•   Diphtheria
•   Acute-on-chronic stridor e.g. a floppy larynx
    (laryngomalacia)
Acute Laryngotracheobronchitis-1
Age
Location
Aetiology
Onset
Stridor
Retractions
Voice
Position &
appearance
 Acute Laryngotracheobronchitis-1
Age                        6/12 – 3 years
Location      Subglottic
Aetiology     Parainfluenza, influenza, RSV; rarely
              Mycoplasma, adenoV, measles
Onset         Insidious, URTI
Stridor       Yes
Retractions   Yes
Voice         Hoarse
Position &    Normal
appearance
  Acute Laryngotracheobronchitis-2
Swallowing
Barking
cough
Toxicity
Fever
X-ray
WBC count
Treatment
Prevention
Acute Laryngotracheobronchitis-2
Swallowing Normal
Barking    Yes
cough
Toxicity     Rare
Fever        <38C
X-ray        Subglottic narrowing/ steeple sign
WBC count    Normal
Treatment    Oral Dexamethasone/Neb. Budesonide
Prevention   None
Sign ?
Sign ?
          Spasmodic Croup-1

Age
Location
Aetiology
Onset
Stridor
Retractions
Voice
Position &
appearance
      Spasmodic Croup-1
Age                    3/12 – 3 years
Location    Subglottic
Aetiology   Unknown
Onset       Sudden onset at night; prior
            episodes
Stridor     Yes
Retractions Yes
Voice       Hoarse
Position & Normal
appearance
             Spasmodic Croup-2

Swallowing
Barking cough


Toxicity
Fever
X-ray
WBC count
Treatment
Prevention
            Spasmodic Croup-2
Swallowing Normal
Barking      Yes
cough
Toxicity     No
Fever        None
X-ray        Subglottic narrowing
WBC count Normal
Treatment    Occasionally Steroids needed
Prevention   None
?
              Epiglottitis - 1
Age
Location
Aetiology
Onset
Stridor
Retractions
Voice
Position &
appearance
               Epiglottitis - 1
Age                      2 – 6 years
Location      Supraglottic
Aetiology     HIb & HIa
Onset         Rapid short prodrome
Stridor       Yes – soft inspiratory
Retractions   Yes
Voice         Muffled
Position &    Tripod, leaning forward;
appearance    agitated
                Epiglottitis -2
Swallowing
Barking cough


Toxicity
Fever
X-ray
WBC count
Treatment
Prevention
               Epiglottitis - 2
Swallowing Drooling
Barking      No
cough
Toxicity     Severely toxic
Fever        > 38.5 C
X-ray        Thumb sign of thickened epiglottis
WBC count    High Neutrophil count
Treatment    Entotracheal Intubation involve senior
             Anaesthetist/ ENT Consultant. IV antibiotic
Prevention   None
?
        Retropharyngeal Abscess-1
Age
Location
Aetiology
Onset
Stridor
Retractions
Voice
Position &
appearance
      Retropharyngeal Abscess-1
Age                     < 6 years
Location      Posterior pharynx
Aetiology     S aureus, anaerobes
Onset         Insidious to sudden
Stridor       None
Retractions   Yes
Voice         Muffled
Position &    Arching of neck or normal
appearance
     Retropharyngeal Abscess-2
Swallowing
Barking cough


Toxicity
Fever
X-ray
WBC count
Treatment
Prevention
    Retropharyngeal Abscess-2

Swallowing Drooling
Barking      No
cough
Toxicity     Severely toxic
Fever        > 38 C
X-ray        Thickened Retropharyngeal space
WBC count    High Neutrophil count
Treatment    IV antibiotic +/- surgical drainage

Prevention   None
              Angioedaema-1
Age
Location
Aetiology
Onset
Stridor
Retractions
Voice
Position &
appearance
              Angioedaema-1
Age                       All ages
Location       Variable
Aetiology      Congenital C1-esterase deficiency
Onset          Sudden
Stridor        Yes
Retractions    Yes
Voice          Hoarse, may be normal
Position &     Normal; may have facial oedema,
appearance     anxiety
                Angioedaema-2
Swallowing
Barking cough


Toxicity
Fever
X-ray
WBC count
Treatment
Prevention
             Angioedaema-2
Swallowing Normal
Barking      Possible
cough
Toxicity  No, unless anaphylactic shock/severe
          anoxia
Fever     None
X-ray     Subglottic narrowing/ steeple sign
WBC count Normal
Treatment    High Flow O2, Epinephrine, IV fluids, IV
             Hydrocortisone; danazol, C1-esterase
             Infusion
Prevention   Avoid allergens; FFP; danazol
?
      Laryngeal Papillomatosis-1
Age
Location
Aetiology
Onset
Stridor
Retractions
Voice
Position &
appearance
  Laryngeal Papillomatosis-1
Age                      3/12 – 3 years
Location      Larynx, vocal cords, trachea
Aetiology     Human Papilloma Virus (HPV)
Onset         Chronic
Stridor       Possible
Retractions   No
Voice         Hoarse
Position &    Normal
appearance
     Laryngeal Papillomatosis-2
Swallowing
Barking cough


Toxicity
Fever
X-ray
WBC count
Treatment
Prevention
   Laryngeal Papillomatosis-2
Swallowing Normal
Barking     Variable
cough
Toxicity    None
Fever       None
X-ray       May be normal
WBC count   Normal
Treatment  Laser Therapy, repeated excision,
           Bleomycin, interferon
Prevention Treat maternal genitourinary lesions;
           consider Caesarean Section
Can a haemangioma cause an
    airway obstruction ?
    Lower Airway Diseases - Acute
•   Asthma
•   Bronchiolitis
•   FB
•   Aspiration of Gastric contents
    Asthma - assessment of severity
•   Altered consciousness or agitation
•   Exhaustion
•   Ability to talk – sentences, phrases or words
•   Feeding & drinking
•   Central cyanosis
•   Accessory muscle use
•   Sternal recession
•   Heart rate ( >6 years) 100, 100-120, >120
•   Wheeze
•   Pre-neb sats: >93%, 91-93% & <90%
•   PaCO2: > 5 kpa
         Acute severe asthma
• High flow oxygen 10-15 litres (mask & res)
• Neb Salbutamol +/- Ipratobium – 20 -30min
• IV access
• IV Hydrocortisone 4mg/kg x 4 hours
• IV Salbutamol 15 mcg/kg (5mcg/kg <2 yrs) over
  10 min – 1-5 mcg/kg infusion
• +/- IV Aminophylline Infusion 5mg/kg 15-20 min
•
    Lower Airway Diseases - Chronic
• Asthma – reactive airway disease
• Hypersensitivity reactions
• Tracheo-bronchomalacia
• Vocal cord adduction
• Airway compression
• Aspiration (FB, GOR, Swallowing dysfunction,
  TOF)
• Bronchiectasis, CF, PCD (ICS), Tumours,
  Bronchiolitis obliterans, post BPD
• CCF

								
To top