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Pediatrics Lower Airway (Asthma (Foreign Body Airway Obstruction (FBAO)…

- - - - Pt: :boy::skin-tone-2: <3yo suddenly unattended :tongue::earth_asia: & sudden onset dyspnea (SOB)
        
        Extrathoracic Lesions
        
        Inspiratory stridor
        
        above clavicles: ENT's job
        
        Intrathoracic Lesions
        (in chest)
        
        Expiratory wheeze (no problem opening, but resistance when lungs close)
        
        need pulmonary's help
        
        Dx: Where did the object go?
        
        2 view XR (Coin Sign AP & Lat)
        
        Objects always oriented front-back in trachea (Negative Coin sign AP/ Pos Coin sign on lateral)
        
        Pos Coin Sign on AP is not in trachea
        
        Tx: Get the object (ENT or Pulm)
        
        rigid tool retrieves FB :earth_asia:
        
        Abx (prob not necessary)
        
        Pulmonary location: Bronchoscopy :telescope:
        
        most likely if SOB
        
        1 more item...
  - - - Dx: PFT on 1st visit
        
        FEV1/FCV is low
        
        reversed w/ bronchodilators (ß agonists)
        
        or induced w/ methacholine
        
        Tx: Kids :boy: should avoid triggers
        
        :forbidden::dog: no pets
        
        :forbidden: carpets, pillows, upholstery
        
        smoking cessation :no_smoking:
        
        Rx: to control sx
        
        done in escalating fashion, more severe = more Rx
        
        SABA
        
        ICS
        
        higher dose ICS or LTE antagonists
        
        LABA ( :warning: needs ICS or :skull_and_crossbones:)
        
        PO steroids
        
        :pencil2:make sure they use the inhalers correctly. Anytime pt has uncontrolled asthma = watch them use the inhaler, give them a spacer. Then, you can add Rx
- - - - Really, don't Tx if you are certain
        
        Except if ED visit and looks SAS...
        Dx: CXR (PNA r/o)
        
        ß agonist (asthma r/o)
        
        CBC (sepsis r/o)
        
        :warning:you don't have to do this if you have the right clinical picture (:snowflake::baby::skin-tone-2:)
        
        Tx: ~~ß agonists~~
        ~~steroids~~
        ~~Abx~~
        ~~RSV antigen, PCR, etc~~
        Hospital admission & O2 & fluids :ocean:
        
        Sx peak at days 3-4
        
        mostly theyre so sick they can't feed, so we admit for nutrition & parental assurance (we can't really do anything)
        
        F/u: Hypoxemic Respiratory Failure & ARDS can happen
  - - - Pt: Comes already diagnosed
        
        Prenatal screen (nationwide)
        
        :warning:watch out for immigrants :man_with_gua_pi_mao::skin-tone-2: or homeopathic types = no neonate screening
        
        mild version possible
        
        meconium ileum on day of birth :baby::skin-tone-2:(presumptive dx ; f/u w/ testing)
        
        Recurrent pulm infections :boy::skin-tone-2: older kids
        
        Failure to thrive :seedling:(no exocrine function)
        
        Baby :baby::skin-tone-2: tastes salty
        
        Tx:
        
        Screen
        
        confirm: Sweat Chloride test :sweat_drops: (>40 in infant :baby::skin-tone-2:; >60 in everyone else)
        
        Tx: Lung
        
        aggressive pulmonary toilet :toilet: (move secretions)
        
        Pseudomonas (Staph Aureus in infants :baby::skin-tone-2:)
        
        Tx: Pancreas
        
        Replace pancreatic enzymes
        
        Supplement ADEK
        
        Life expectancy = 45 yo
        
        Malnourished & short stature (FTT :seedling:)
        
        Need genetic counseling
        
        likely infertile :male_sign:
        
        don't want to pass disease to someone else