COMMON RESPIRATORY INFECTIONS I have a … for a pediatric board review textbook I co-edited. Objectives ¨ Review common pediatric respiratory infections including ¤ ...
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COMMON RESPIRATORY INFECTIONS – ARE THERE UPDATES?
Kelly E Wood, MD Clinical Associate Professor University of Iowa Stead Family Children’s Hospital Stead Family Department of Pediatrics
I have a financial relationship with McGraw Hill Professional for a pediatric board review textbook I co-edited.
Objectives
¨ Review common pediatric respiratory infections including ¤ Pathophysiology ¤ Management ¤ Complications
¨ Provide evidence based recommendations when available
From: IV. Nontrauma Emergencies CURRENT Diagnosis & Treatment Emergency Medicine, 7e, 2011
What is shown on this x-ray?
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Clinical Presentation
Drooling and wants to be upright!
Balfour-Lynn I et al. Acute Infections that Produce Upper Airway Obstruction. Kendig and Chernick’s Disorders of the Respiratory Tract in Children. 2012:424-436.
Epiglottis
¨ Bacterial infection – Haemophilus influenzae type b (Hib)
¨ Unimmunized / asplenia
¨ Life Threatening
¨ Treatment ¤ Secure airway first ¤ Antibiotics
Epiglottis
Rogers D et al. Epiglottitis due to nontypeable Haemophilus influenzae in a vaccinated child. International Journal of Pediatric Otorhinolaryngology. 2010;74(2):218-220. Congenital Disorders of the Larynx. http://clinicalgate.com/congenital-disorders-of-the-larynx. Accessed August 16, 2016.
From Benjamin B. The pediatric airway, slide #2, Slide Lecture Series. American Academy of Otolaryngology–Head and Neck Surgery, 1992.
Contrasted CT of a left retropharyngeal abscess (arrow).
Legend:
From: Section 19. Eyes, Ears, Nose, Throat, and Oral Surgery Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e, 2011
Management
¨ Admission ¤ Access to Otolaryngologists
¨ Imaging
¨ Antibiotics ¤ Include MRSA and anaerobic coverage
¨ Surgery ¤ Airway impingement ¤ Mature abscess > 2-3 cm ¤ Failed 24-48 IV antibiotics
¨ Dexamethasone Source: Influenza, Parainfluenza, Respiratory Syncytial Virus, Adenovirus, and Other Respiratory Viruses, Sherris Medical Microbiology, 6e Citation: Ryan KJ, Ray C. Sherris Medical Microbiology, 6e; 2014 Available at: http://accessmedicine.mhmedical.com/ViewLarge.aspx?
¨ Management depends on size and degree of respiratory compromise
¨ 3rd generation cephalosporin and MRSA coverage
Bradley et al. The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. first published online August 30, 2011 doi:10.1093/cid/cir531
Empyema Imaging
Muller N, et al. Empyema. High-Yield Imaging: Chest. 2010:581-583. Bishay M, et al. Efficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study. J Pediatr Surg. 2009;44(2):337-342.
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References
¨ Bjornson CJ, Johnson DW. Croup in children. CMAJ. 2013;185:1317-1323. ¨ Bradly JS, Byington CL, Shah SS, et al. The management of community-
acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical Infectious Diseases. 2011. http://cid.oxfordjournals.org/content/early/2011/08/30/cid.cir531.full. Accessed November 11, 2016.
¨ Escobar ML and Needleman J. Stridor. Pediatrics in Review. 2015;36:135-137.
¨ Marinati LC and Boner AL. Clinical diagnosis of wheezing in early childhood. Allergy. 1995;50:701-710.
¨ Richards AM. Pediatric Respiratory Emergencies. Emerg Med Clin N Am. 2016; 34:77–96.
¨ Virbalas J and Smith L. Upper Airway Obstruction. Pediatrics in Review. 2016;36;62-73.