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RESPIRATORY PAEDIATRICS

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RESPIRATORY PAEDIATRICS Dr Pamela Lewis – PowerPoint PPT presentation

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Title: RESPIRATORY PAEDIATRICS


1
RESPIRATORY PAEDIATRICS
  • Dr Pamela Lewis

2
6yr Male Emergency Department
  • Sudden onset wheeze and DIB
  • Preceding URTI
  • Atopic
  • Interval symptoms

3
Acute AsthmaAssessment of severity
  • Talking
  • Respiratory rate
  • Accessory muscle use
  • Heart rate
  • Oxygen saturations
  • Peak Flow

4
Acute 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

5
Asthma- Chronic Management
  • Interval symptoms and exacerbations
  • Adherence
  • Inhaler and spacer technique
  • Growth
  • Examination
  • PF FEV1/FVC
  • Medication BTS stepwise approach
  • www.brit-thoracic.org.uk

6
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7
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8
3 month Female Emergency Department
  • Cough, coryza, fever and poor feeding
  • Preterm 25/40, oxygen until 6 wks of age
  • Parental smoking
  • Respiratory distress with bilateral crackles and
    wheeze

9
Bronchiolitis assessment
  • Feeding (lt50)
  • RR (gt70)
  • Nasal flare, grunting,recession
  • Oxygen sats lt92
  • History of apnoeas

10
Bronchiolitis 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

11
10 Yr Male Emergency Department
  • 2 days cough, fevergt 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

12
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13
Pneumonia Management
  • ABC and Oxygen
  • Fluids
  • Antibiotics
  • CXR BC FBC Electrolytes
  • Sputum culture
  • Complications Empyema, SIADH
  • www.brit-thoracic.org.uk

14
4 yr Female Emergency Department
  • Temperature 40, marked respiratory distress, soft
    stridor, drooling
  • Unvaccinated

15
Epiglotitis
  • SHOUT FOR HELP
  • Senior anaesthetist, paediatrician, ENT
  • Rapid sequence induction of anaesthesia
  • Antibiotics ceftriaxone (Hib)

16
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17
Childrens Outpatients6 month Male
  • Recent arrival in UK ( Europe)
  • FTT
  • Recent right upper lobe pneumonia
  • Loose stools, good appetite
  • Examination, weight lt 0.4th (BW 50th) cough and
    mild i.c recession

18
Cystic Fibrosis
  • AR chromosome 7, CFTR defect ,DF508
  • UK 12500, gene carrier 125
  • Multi organ involvement
  • Respiratory decreased mucocilliary clearance,
    diminished local defences and increased bacterial
    adherence, progressive loss of respiratory
    function

19
CF Diagnosis
  • UK screening programme
  • Heel Test at 6 days IRT
  • Genetic testing CF mutations
  • Sweat test Chloride gt 60 (sodium lt Chloride)

20
CF Management
  • Multi disciplinary
  • Infections prophylactic and treatment
  • Nutrition
  • Physiotherapy
  • Psychology
  • Screening for complications liver, diabetes

21
Childrens Outpatients 3yr Female
  • Refugee from Somalia
  • Protracted cough, fevers, FTT
  • Limited Family history no vaccination history
  • CXR hilar lymphadenopathy and RUL collapse

22
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23
TB Diagnosis
  • Latent v Active TB
  • Mantoux lt 6mm negative, gt6mm positive in those
    without prior BCG, gt15mm positive in those with
    BCG
  • Consider Gamma Interferon testing
  • Sputum
  • DONT FORGET HIV

24
Treatment TB
  • 6 month regime
  • 2 months Rifampicin, isoniazid, pyrayinamide and
    ethambutol then
  • 4 months rifampicin and isoniazid
  • DOTS
  • Public health and contact tracing
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