Respiratory infections Dr. Tara Husain. airway is divided into 3 anatomic parts extrathoracic airway...
Transcript of Respiratory infections Dr. Tara Husain. airway is divided into 3 anatomic parts extrathoracic airway...
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Respiratory infectionsDr. Tara Husain
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airway is divided into 3 anatomic parts
extrathoracic airway ; from the nose to the thoracic inlet
intrathoracic-extrapulmonary airway ; from the thoracic inlet to the main stem bronchi
intrapulmonary airway is within the lung parenchyma
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SIGN
EXTRATHORACIC AIRWAY OBSTRUCTION
INTRATHORACIC-EXTRAPULMONARY AIRWAY OBSTRUCTION
INTRAPULMONARY AIRWAY OBSTRUCTION
PARENCHYMAL PATHOLOGY
Tachypnea + + ++ ++++
Retractions ++++ ++ ++ +++
Stridor ++++ ++ − −
Wheezing ? +++ ++++ ?
Grunting ? ? ++ ++++
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Cough; results from stimulation of irritant receptors located in the airway mucosa including the ear
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Causes of Acute Cough; Acute respiratory infection. pulmonary edema. chemical irritation. Foreign body aspiration
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Causes of chronic cough; Allergy ( asthma, allergic rhinitis) Anatomical abnormality ( tracheo-
esophageal fistula, Gastroesophageal reflux).
Chronic infection; cystic fibrosis Immunodeficiency. Environmental exposure Ticks.
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Croup (Laryngotracheobronchitis) It is acute infectious
laryngotrachiobronchitits. parainfluenza virus type 1 and 2 are the
most common agents Usually affects children between6 months-
3 years,
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Clinical presentation; starts by symptoms of upper respiratory tract
infection(common cold) , then a brassy cough typically sounding like a
barking seal Then inspiratory stridor and respiratory distress Symptoms are characteristically worse at night
and often recur with decreasing intensity, until about 1 wk
Most cases are mild and self limited, Rarely there may be very sever airway
obstruction necessitating artificial airway
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Examination; suprasternal, intercostal and
subcostal retractions,. There may also be associated lower
airway obstruction manifested by wheeze or expiratory rhonchi
PA XR ; (Steeple) sign of narrowed subglottic space.
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Treatment; Aerosolized raceme epinephrine reduces
edema temporarily(about 2 hours), in sever cases it may need to be repeated every 20 minutes. A case needing this treatment needs hospital admission
Corticosteroids ; systemic or inhaled dexamethasone (0.15 mg/kg) single dose helium-oxygen mixture (Heliox) may be
effective in children with severe croup for whom intubation is being considered
Antibiotics not indicated Over the counter cold medication not
indicated
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Indications for hospital admission;
progressive stridor severe stridor at rest respiratory distress hypoxia Cyanosis depressed mental status poor oral intake need for reliable observation
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Epiglottitis Pediatric emergency inflammation of the epiglottis and/or the
supraglottic tissues surrounding the epiglottis predominantly bacterial ( H. influenzae type b).
Usually in children between 2-7 years otolaryngologist or general surgeon and
anesthesiologist should be consulted
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Clinical presentation; sudden onset high fever Respiratory distress fulminate progression sever dysphagia and a muffled
voice Patients usually sit erect and they
may drool from there mouth because of dysphagia
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Diagnosis; Thumb sign on lateral neck x-ray
differentiates epiglottitis from sever croup
Laryngoscope examination to inspect the epiglottis which shows cherry red enlargement
Blood culture and culture from the surface of the epiglottis
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Treatment; 1-Endotracheal intubation is the preferred method
of treatment. most patient can be safely extubated with in 48-72 hours
Antibiotics ( ceftriaxon) should be given. All patients should receive oxygen unless the mask
causes excessive agitation Racemic epinephrine and corticosteroids are
ineffective Minor procedures, such as intravenous access, may
cause respiratory distress and can be performed more safely after intubation
Examination of the tonsills by toungue depresser is contraindicated unless in operative theater
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Bronchiolitis; Is predominantly a viral disease. RSV is responsible for >50% of cases Other agents include parainfluenza adenovirus, Mycoplasma. occur in winter or early spring Older family members are a common source of
infection; they might only experience minor upper respiratory symptoms (colds)
Host anatomic and immunologic factors play a significant role in the severity
Co-infection with >1 virus can also alter the clinical manifestations and/or severity of presentation
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Clinical presentation; rhinorrhea, cough, and low grade
fever, followed in several days with the
onset of rapid breathing and wheezing.
The child may feed poorly and may have sleeping disturbance.
Acute symptoms last for 5-6 days, recovery is complete usually after 10-
14 days
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Examination;
dyspnea, intercostal and subcostal
retraction, Tachypnea prolonged expiratory phase, in very sever cases there may be
cyanosis
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Differential diagnosis; Congenital malformations; vascular
ring, left ventricular enlargment, intrinsic abnormality
Foreign body aspiration Gastroesophageal reflux Trauma; aspirations, burns, or scalds of
the tracheobronchial tree tumors
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Diagnosis; CXR; typically shows air trapping and
may show peribronchial, thickening, there may be atelectasis, or infiltrates
WBC count is usually normal RSV may be isolated from
nasopharyngeal secretions by PCR,culture
Hypoxemia may occur secondary to ventilation perfusion mismatch.
Hypercapnia is rare occurring in severely affected infants with sever airway obstruction and respiratory fatigued
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Treatment; Oxygen; Humidified oxygen should be given
to maintain oxygen saturation of more than 93%.
Bronchodilators; such as aerosolized beta agonist or racemic epinephrine may be beneficial in selected patients
Corticosteroids; offer little benefit. Antibiotics; are not indicated unless there is
evidence of secondary bacterial infection Ribavirin aerosol; a specific antiviral agent
RSVit has been demonstrated to be mildly effective. It is considered in patients with high risk disease
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Mechanical ventilation; required to treat respiratory failure or apnea.
monthly injections of RSV monoclonal antibodies for infants and toddlers under 2 years with bronchopulmonary dysplasia
Supportive measures; Intravenous fluid, if there is poor oral intake