RESPIRATORY PAEDIATRICS Dr Pamela Lewis. 6yr Male Emergency Department Sudden onset wheeze and DIB Preceding URTI Atopic Interval symptoms.

RESPIRATORY RESPIRATORY PAEDIATRICSPAEDIATRICS

Dr Pamela LewisDr Pamela Lewis

6yr Male Emergency 6yr Male Emergency DepartmentDepartment

• Sudden onset wheeze and DIB• Preceding URTI• Atopic• Interval symptoms

Acute AsthmaAcute AsthmaAssessment of severityAssessment of severity

• Talking• Respiratory rate• Accessory muscle use• Heart rate• Oxygen saturations• Peak Flow

Acute Asthma ManagementAcute Asthma Management• ABC and Oxygen• B2 Agonist (LVS or Neb)• Steroids (oral prednisolone/iv

hydrocortisone)• Ipratropium bromide neb• Aminphyline/iv salbutamol• Magnesium sulphate• www.brit-thoracic.org.uk

Asthma- Chronic Asthma- Chronic ManagementManagement

• Interval symptoms and exacerbations• Adherence• Inhaler and spacer technique• Growth• Examination • PF FEV1/FVC• Medication BTS stepwise approach• www.brit-thoracic.org.uk

3 month Female Emergency 3 month Female Emergency DepartmentDepartment

• Cough, coryza, fever and poor feeding

• Preterm 25/40, oxygen until 6 wks of age

• Parental smoking• Respiratory distress with bilateral

crackles and wheeze

Bronchiolitis assessmentBronchiolitis assessment• Feeding (<50%)• RR (>70)• Nasal flare, grunting,recession• Oxygen sats <92%• History of apnoeas

Bronchiolitis ManagementBronchiolitis Management• Oxygen• Fluids• Consider blood investigations if diagnosis

in doubt or severe• CXR not routine• In deterioration CPAP/IPPV• Palivixumab prophylaxis for risk groups• www.sign.ac.uk

10 Yr Male Emergency 10 Yr Male Emergency DepartmentDepartment

• 2 days cough, fever> 39, abdominal pain and rigors

• No prior respiratory history• HR 130 Refill 3 seconds BP 100/60

RR 36 dull to PN right base with crackles

Pneumonia ManagementPneumonia Management• ABC and Oxygen• Fluids • Antibiotics• CXR BC FBC Electrolytes• Sputum culture• Complications Empyema, SIADH• www.brit-thoracic.org.uk

4 yr Female Emergency 4 yr Female Emergency DepartmentDepartment

• Temperature 40, marked respiratory distress, soft stridor, drooling

• Unvaccinated

EpiglotitisEpiglotitis• SHOUT FOR HELP• Senior anaesthetist, paediatrician,

ENT• Rapid sequence induction of

anaesthesia• Antibiotics ceftriaxone (Hib)

Childrens OutpatientsChildrens Outpatients6 month Male6 month Male

• Recent arrival in UK ( Europe)• FTT • Recent right upper lobe pneumonia• Loose stools, good appetite• Examination, weight < 0.4th (BW 50th)

cough and mild i.c recession

Cystic FibrosisCystic Fibrosis• AR chromosome 7, CFTR

defect ,DF508• UK 1:2500, gene carrier 1:25• Multi organ involvement• Respiratory: decreased mucocilliary

clearance, diminished local defences and increased bacterial adherence, progressive loss of respiratory function

CF DiagnosisCF Diagnosis• UK screening programme• Heel Test at 6 days IRT • Genetic testing CF mutations• Sweat test Chloride > 60 (sodium <

Chloride)

CF ManagementCF Management• Multi disciplinary• Infections prophylactic and treatment• Nutrition• Physiotherapy• Psychology• Screening for complications: liver,

diabetes

Childrens Outpatients 3yr Childrens Outpatients 3yr FemaleFemale

• Refugee from Somalia• Protracted cough, fevers, FTT• Limited Family history no vaccination

history• CXR hilar lymphadenopathy and RUL

collapse

TB Diagnosis TB Diagnosis • Latent v Active TB• Mantoux < 6mm negative, >6mm

positive in those without prior BCG, >15mm positive in those with BCG

• Consider Gamma Interferon testing• Sputum• DON’T FORGET HIV

Treatment TBTreatment TB• 6 month regime• 2 months Rifampicin, isoniazid,

pyrayinamide and ethambutol then• 4 months rifampicin and isoniazid• DOTS• Public health and contact tracing