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RESPIRATORY PAEDIATRICS

RESPIRATORY PAEDIATRICS. Dr Pamela Lewis. 6yr Male Emergency Department. Sudden onset wheeze and DIB Preceding URTI Atopic Interval symptoms. Acute Asthma Assessment of severity. Talking Respiratory rate Accessory muscle use Heart rate Oxygen saturations Peak Flow.

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RESPIRATORY PAEDIATRICS

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  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. 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

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

  8. 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

  9. 10 Yr Male Emergency Department • 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

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

  11. 4 yr Female Emergency Department • Temperature 40, marked respiratory distress, soft stridor, drooling • Unvaccinated

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

  13. Childrens Outpatients6 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

  14. Cystic 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

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

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

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

  18. 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

  19. 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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