سشنات د.فارس pdf - طلاب كروب C

Lec.1

Pediatrics

stage

Session notes

د.فارس الصواف

Respiratory emergencies

Notes:



Melena : Shiny black tary stool



Viral hepatitis : presented with jaundice , hepatomegaly ,
abdominal pain and the most important symptom is loss of
appetitte , so try to save the pateint with good feeding , well
dehydration , encourge carbohydrate intake and avoid diet
restriction

Respiratory ER :

Croup : is not an emergent condition , but need monitoring in the
severe cases to resuscite the patient by endotracheal intubation , or
tracheostomy if there is any total upper air way obstruction that may be
associated with disturbed level of conciousness

Use steriod on demand ( dont let the patient die before giving him
steriod )

Steriod can be used until 2 weeks safely ( 1 weeks on the textbooks)

Acute epiglottitis:



It is life threatening condition (Total airway obstruction).



Severe bacterial infection of epiglottis and subepiglottic fold.



Bacteria : Hemophilus infleunzae type b, Strep.pyogens



Features : sudden onset, high fever, toxic, sore throat, dysphagia,

triode position, drooling of saliva, dyspnea, collapse, coma, death (in few
hours).



Clinical diagnosis (not use tongue depressor



lead to respiratory

obstruction)



Don’t take history, don't do x-ray.



Blood culture investigation is hazardous.



Do examination in theater room with available tools for intubation,

tracheostomy and anesthesia.



All children need intubation for 2-3 days.



Antibiotics : for H.infleunzae (amoxicillin or ceftriaxone) for 7-10 days 3



Then send child to home.



Give rifampicin to house hold members for 2 days to prevent

meningitis due to H.infleunzae.

Avoid ceftriaxone in children espicially with breast feeding

Procaine pencillin best drug for H.inf

Chloramphenicol also can be used ( S/E : aplastic anemia )

Some medical schools administer steriod for aryepiglottic fold
inflammation

Foreign body inhalation (aspiration)



Common in infants and toddlers.

(Infant can swallow F.B because they explore environment by their

mouth).

فستق،سمش بح ،زرخ ،لباعد

:like things small Inhale



History : very important, healthy baby, sudden onset, parent deny

something (social circumstances).



Cause acute strider.



First stage : severe paroxysm of cough, cyanosis, chock, sneezing,

gagging.



Second stage : Misleading (like a recovery state).



Third stage : symptoms of complications because F.B go to the right

lung and lead to atelectasis, pneumonia, tachypnea, cyanosis,
retractions, fever, and other symptoms.



Diagnosis clinically.



Investigations : CXR should be done in deep inhalation see localized

hyperinflation, most are radio-lucent.



Treatment : upside down, big thrust on baby back, laryngoscope or

bronchoscope, tracheostomy (trans-thoracic approach).

In presistent pnemonia think about FB inhalation

Or H-type TEF fistula in slowely resolving pnemonia

Penmonia :

The commonest bacteria in pneumonia in all age groups are strepto
pnemoniae, H.influenzae.

o Neonate (less than 3 or 4 weeks) : group B strepto, E.coli, G+ bacillus.
o Pneumonia in neonate is like septicemia : give parenteral antibiotics
for two weeks then admission.

o After neonate : viral infection.

o After 3 months : chlamydia, uroplasma, mycoplasma.

o After age of 5 years : most common is strepto pneDiagnosis by CXR



obacity, patchy infiltrate (viral), lobar infiltrate (viral).



Staph. pneumonia:

o High fever, toxic, dramatic and progressive course.

o CXR very characteristic : lung abscess, empyema, plural effusion,
pneumatocele.

o Come with septicemia and coma.

o Blood culture (+ve in 10% only)

o Give anti-staph drugs. ( vancomycin , gentamicin , fluxacilliin )

with supportive treatment , IV fluid , monitoring

bronchiactasis bestly treated by physiotherapy and antibiotics



For mycoplasma pneumoniae azithromycin or clarithromycin.



For pneumococcus amoxicillin for 7-10 days (40-100 mg/kg in day)



Indication for hospital admission:

o Need O2. o Less than 6 months age.

o Need fluid and supplements.

o Immuno-deficient baby.

o Slowly resolving pneumonia.

o Multiple infections. umoniae then mycoplasma pneumonia.

Status asthmaticus

Chest X-ray (CXR):

o Is indicated in: 1- First attack to exclude other DDx (no need to repeat
CXR in the other attack).

2- If we treating the patient with his good compliance but the patient
condition still NOT stable, perform CXR to diagnose complications or to
exclude other Diseases

. o Findings like pneumothorax, atelectasis, mediastinum widening



Peak expiratory flow (PEF):

o Very important but is indicated in children who are 6 years old age or

Short acting B agonist (SABA).



Inhaled Side effects less than oral one.



Side effects like tachycardia, hyperkalemia, tremor.



It is bronchodilator.



Like salbutamol, albuterol.



0.5 ml



for less than 5 years // 1 ml



for more than 5 years ((only ml,

not ml/kg)



Very effective.



Give it with 2 ml of normal saline



use nebulizer.



Oral is as effective as parenteral.

Treatment:



Admission to ICU

Monitoring

two rescue treatment

Inhaled and systemic corticosteroids

aminophylline infusion

Mg sulfate (IV 75 mg/kg)



ipratropium bromide

terbutaline

adrenaline (0.01 mg/kg) SC or IM (very painful)

Ventilator.



No need for



Oral beta 2 agonist / Ketotifen (anti-histamine) /

Antibiotics /Oral bronchodilators (side effects).

Aminophylline :

Give it by infusion

The bolus dose 5 mg/kg ( slowely )

Maintenance 0.7-1 mg/kg by infusion pump

Dont give aminophylline in supine position , give it in lying postions

S/E : seizure , arrythemia , vomiting , hypotension

Socail management with action plan ( how they use the spacer , allergen
avoiding , sign of severity , )

Spiromety not used in children < 7 years not – cooperative

Bronchiolitis:



Common wheezy infection.



Occur in few months up to 2 years



Above 5 years rare.



Viral infection (RSV).



Rarely mycoplasma pneumoniae.

