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19 Cards in this Set
- Front
- Back
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Ddx of tachypneic newborn
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Transient tachypnea of the newborn
Respiratory distress syndrome (formerly hyaline membrane disease) Pneumothorax Hypothermia Congenital heart disease CHF Cyanotic congenital heart disease Pneumonia/sepsis Meconium aspiration syndrome |
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"Score" used to age a baby
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Ballard score
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Also known as hyaline membrane disease.
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RDS
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Therapy for RDS
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Optimize perinatal care:
Administration of Betamethasone before delivery Administration of surfactant down the endotracheal tube. Ampicillin prior to delivery if any suspicion of sepsis or infection Supportive care: Mechanical ventilation IV nutrition until able to take orally |
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Presumptive bacterial antibiotics
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Regional variations – Ampicillin/Gentamicin; Penicillin/Kanamycin, Ampicillin/Cefotaxime are all respected regimens
Why the Ampicillin in all 3? What organisms? |
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Presumptive antiviral
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Any suspicion of HSV infection by history and physical
Acyclovir until proven NOT to be HSV |
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Therapy for meconium aspiration
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Antibiotics since this is pneumonitis and presumptively at least needs treatment for 48 hours until blood culture is negative OR a conservative 7 days course
Mechanical ventilation – may be quite difficult as they tend to a pattern of persistent pulmonary hypertension and may be very tough to oxygenate May need ECMO = Extra corporeal membrane oxygenation |
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Two patterns of congenital HD:
Volume overload causing congestive heart failure. Which lesion would be typical? Cyanotic presentation with murmur or that does not correct with oxygenation or intubation --> consider cyanotic heart disease and get out those prostaglandins! |
Two patterns of congenital HD:
Volume overload causing congestive heart failure. Which lesion would be typical? VSD Cyanotic presentation with murmur or that does not correct with oxygenation or intubation --> consider cyanotic heart disease and get out those prostaglandins! |
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DDX of increasing cough, difficulty breathing, and irritability
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Asthma exacerbation
Bronchiolitis Pneumonia Croup Epiglottitis Pertussis Inhaled foreign body |
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Airway – how would we assess?
Breathing – how would we assess? Circulation – how would we assess? |
Kylie has good respiratory excursions and has audible breath sounds
She is tachypneic and has some retractions and nasal flaring, but she is “pink” in color Her heart rate is increased, but she has good strong pulses and good capillary refill |
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Cough and cold med for children under 2
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none
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Inspiratory breath sounds rule out what diseases from our DDX?
(Must be extrathoracic if the predominant sound is inspiratory ) |
asthma
pneumonia bronchiolitis |
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If breath sound is dynamic, then it is an obstructive illness; fixed it is a __________ illness
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If breath sound is dynamic, then it is an obstructive illness; fixed it is a restrictive illness
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Obstructive upper airway dx
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Croup (Laryngotracheobronchitis):
Infectious – Parainfluenza, RSV, Influenza A, Rhinovirus, Adenovirus, and Coxackievirus Spasmodic Other airway infections – bacterial tracheitis, epiglotititis, retropharyngeal and other airway abscess |
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Restrictive upper airway illness
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Congenital – webs, rings, and slings
Acquired – subglottic stenosis from prolonged intubation |
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Causes of epiglottitis
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Predominance of Hemophilus influenza type B (HIB), with other expected pathogens possible – Streptococcus pneumoniae, Group A Strep (pyogenes), Staphylococcus aureus
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Diphtheria toxin catalyzes the ADP-ribosylation of, and inactivates, the _________ ______ ___-2.[6] In this way, it acts to inhibit translation during eukaryotic protein synthesis
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Diphtheria toxin catalyzes the ADP-ribosylation of, and inactivates, the elongation factor eEF-2.[6] In this way, it acts to inhibit translation during eukaryotic protein synthesis
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Treatment of diphtheria
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Diphtheria anti-toxin, as quickly as possible, even if not confirmed
Supportive care Antibiotics only help to limit spread but do not treat Erythromycin Procaine Penicillin G Alternatives for the pen allergic or erythro vomiters rifampin or clindamycin |
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Tx of pertussis
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Largely supportive
Antitoxin not effective, though the damage is largely toxin-mediated Antibiotics would work in the catarrhal phase, but we rarely see kids in this phase or it appears that this is a simple URI, so rarely used for treatment Antibiotics work in the paroxysmal stage to control spread Erythromycin – but 4 times daily at significant doses Azithromycin and clarithromycin are being investigated and has some theoretical advantages – especially once a day azithromycin |
