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Paediatrics - Respiratory History (Cough (LRTI (viral or bacterial)…
Paediatrics - Respiratory History
Cough
LRTI (viral or bacterial)
Associated lethargy, poor feeding, vomiting, chest pain
Localised abdominal/ neck pain
Fever, cough, tachypnoea
Inflammation of lung tissue causing pus/ exudate build up (CXR changes)
Examination: :arrow_up:RR, :arrow_down::left_right_arrow:SpO2, end-inspiratory crackles, dullness on percussion, decreased breath sounds, bronchial breathing
URTI
Acute otitis media
Ear pain, antibiotics if under 2y
Sinusitis
Pain/ swelling/ tenderness over maxillary sinuses
Analgesia, antibiotics
Sore throat (Pharyngitis/ Tonsillitis)
Normally group B strep, can be group A or EBV (amoxicillin contraindicated)
Inflammation, cervical lymph nodes enlarged
Common cold
Coryza, clinical diagnosis, supportive management
Viral - rhinovirus, coronavirus, RSV
Cystic Fibrosis (recurrent URTIs)
Impaired ciliary function causes retained mucus, chronic infection
Pancreatic ducts blocked by secretions - malabsorption, type 1 diabetes
Meconium ileus due to thick viscoid mucus
GORD, CF liver disease/ cirrhosis, male infertility
Croup, viral induced wheeze, asthma, bronchiolitis, inhaled foreign body
Pertussis (whooping cough)
Spasmodic cough followed by 'whoop'
May turn red/ blue, apnoea common
Highly contagious, PCR/ culture
Isolate, treat with antibiotics
Pneumonia
Typical (rapid onset)
Fever, productive cough,
pleuritic chest pain
, bronchial breathing, crepitations
Strep. pneumoniae, H. influenza
Patchy/ lobar infiltrates (opacity) on CXR
Atypical (slow onset)
Non-pulmonary features e.g. fever, dry cough, myalgia, arthralgia, headache, sore throat, nbausea, vomiting, diarrhoea
Mycoplasma, legionella, chlamydia, strep. pneumoniae, viral pneumonia
Patchy non-lobar infiltrates bilaterally on CXR
SOB
Asthma, viral induced wheeze, pneumonia
Bronchiolitis
most common infant respiratory infection (80% RSV)
Difficulty feeding, apnoeas
Snuffly, crackly, wheezy chest, recessions, tracheal tug
Coryza, dry cough,
increasing dyspnoea
When to admit
Apnoeas, persistently low sats (<92%), less than 50% normal feeds
Significant work of breathing early in the illness, especially if premature
Management
Oxygen (humidified/ AirVo/ CPAP)
NG feeds, smaller more frequent feeds
Noisy breathing
Wheeze (partial obstruction of the lower airways - inflammation/ constriction/ mechanical)
Viral-induced wheeze
Episodic, no interval symptoms - tends to resolve by age 5y
Risk factors - prematurity, maternal smoking, family history of viral wheeze
Coryza, same viruses as common cold
Pneumonia, inhaled foreign body, bronchiolitis
Asthma
Diurnal variation, non-viral triggers, interval symptoms, atopic history and family history, positive response to therapy
Interval symptoms: nocturnal cough, wheeze, chest tightness
Sleep disturbance, sport/ activity limitations, school absence
Difficult to diagnose pre-school (viral/ multi-trigger wheeze)
Bronchial inflammation, bronchial hyper-responsiveness, airway narrowing, symptoms
Acute management
Oxygen, salbutamol, steroids, escalate
Stridor (upper airway obstruction)
Cyanosis, drooling, reduced consciousness indicate impending total obstruction
Croup
Parainfluenza
, rhinovirus, RSV, influenza
ABCDE management, oral dexamethosone (or nebulised adrenaline if severe)
Hoarseness, 'barking cough',
worse/ starts at night
Inhaled foreign body
Epiglottitis (swelling of epiglottis and surrounding tissues)
H. Influenzae type B
Urgent intubation and IV antibiotics
Illness, fever, drooling, rapidly increasing respiratory difficulty, minimal cough, unable to drink/ speak
Other history
BINDS
Prematurity, ventilation, CPR, decreased feeds (quantify), social (pets, smoking, exercise)
FH
Similar issues at home, atopy
PMH
Previous admissions/ ITU, predisposing conditions, atopy
DHA
What taking at home, allergies to food/ medications
HPC
Preceding illness/ choking/ unsupervision
Fevers, rashes, D&V, apnoeas, cyanosis, difficulty feeding, interval symptoms
Onset, evolution, happened before?