Lecture 6 Respiratory distress/Vaccines
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What would you look for in a child in respiratory distress?
What would you listen in a child in respiratory distress?
- Inspiratory Stridor
- Expiratory Grunting
- Adventitious Sounds
What would you check for in a child in respiratory distress?
- Sudden change in behavior
Which are the early signs of impending airway obstruction?
- Nasal Flaring
- Intercostal, suprasternal, substernal retractions
- Increased restless ness
Which are the late signs of impending airway obstruction?
- Sudden agitation or sudden quietness
- child w sever asthma who suddenly stops wheezing
What protects infants and children from respiratory infections?
- IgG from the mother
- hand hygiene
- HiB vaccine
Antibodies are delivered which provide immediate protection against infection, this does not confer lasting immunity.
Forms of passive immunity
- Transplacental - IgG (3rd trimester)
- Breastfeeding - IgA (Colostrum)
- Ig Injections - Given to pts. who have recently been exposed to infection
They stimulate antibody production in the host w/o causing clinical disease
Forms of Active Immunity
Advice for children and caregivers with respiratory infections:
- Don't share cups, towels, washcloths
- Try to avoid children who are well
- Use tissues and dispose them properly
- Good handwashing
- Caregivers - Try not to touch your eyes or nose
How long can RSV survive in the hands?
For 1 hour
What put infants at risk for respiratory infections?
- Immature immunity - Children lack of complete Humoral Immunity until 6 yo
- Prematurity - Baby lacks of IgG
- Anatomy of the respiratory tract - Airway is short and narrow
- Inherited conditions - CF
At what age is FBO most common?
1- 3 yo
Which foods are most dangerous for FBO?
- Hot dogs
- Peanut Butter
Intervention for choking?
Birth to 1 yo
- 5 back blows
- 5 chest thrusts
- If infant becomes unconscious, start CPR
Interventions for choking?
1 yo and up
Interventions for FBO in the lower airways?
FBO, sudden onset of symptoms?
- Sudden coughing or sudden onset of respt. distress
- No fever or other symptoms of illness
What are the respiratory symptoms of Cystic Fibrosis?
- Dry, non-productive cough
- Frequent respiratory infections
What is the diagnostic test for CF?
Sweat chloride test
What is the tx for CF?
- CPT (at least 1 hr Before meals)
- Bronchodilators PRN
- Antibiotics PRN
Why is Surfactant important?
- It is a phospholipid produced by the alveoli
- It peaks at 35 wks gestation
- It keeps alveoli open and allows for a normal breathing
Who is at most risk?
Signs of RDS?
- Preterm infants are at most risk
- Expiratory Grunting
- Nasal Flaring
How can RDS be prevented?
- Try to prevent preterm deliveries
- Give the mother dexamethasone (steroids)
- Give the preterm newborn (<35 wks) surfactant
What is Apnea of prematurity
- Lack of spontaneous breathing for more than 20 sec.
- Tactile stimulation may be helpful
- It can be treated with theophylline or caffeine
What are the signs of Theophylline toxicity?
Name 4 respiratory emergencies
- Status Asthmaticus
Define Status asthmaticus
- Patient with asthma in severe respiratory distress that does not respond to standard treatments
- Can develop slowly or quickly
- Often there is an underlying problem (pneumonia)
What is the treatment for status asthmaticus?
- B2 Agonist (Albuterol, Bronchodilator)
- Terbutaline (Bronchodilator)
- Epinephrine (B1 and B2 Agonist, Bronchodilator)
- Corticosteroids (Anti-inflammatory)
Mention some common asthma triggers
Asthma is an inflammatory response that causes:
- Expiratory wheezing
- Thick tenacious mucus
What are the signs of Epiglottitis?
- Child wakes up with sore throat and high fever
- Sits in a tripod position
What are the don'ts for Epigottitis or Croup (LTB)?
It may cause a laryngospasm
- Don't try to open the mouth
- Don't try to insert any objects or visualize the epiglottis
- Don't try to get a throat culture
What are the do's for Epiglottitis and Croup (LTB)?
Get ready for intubation or tracheostomy
What is the most common causative organism of Epiglottitis?
HiB (Haemophillius Influenza B )
What is croup?
- Laryngotracheobronchitis - Inflammation of the larynx and trachea
- It is caused by a viral infection of the parainfluenza virusIt starts slowly as an upper respiratory tract infection and progresses slowly over a period of days
What are the signs of Croup?
- Toddler starts out with a runny nose
- low-grade fever
- "barking" cough
- Inspiratory stridor
What vaccines are given at 2 mo. of age?
- HiB - Haemophillius Influenza B - Prevents Epiglottitis
- Hep B - Prevents Hepatitis B
- PCV - Pneumococcal Conjugate Vaccine - Prevents Pneumonia
- DTaP - Diphtheria/Tetanus Toxoids/ Acellular Pertussis
- IPV - Innactivated Polio Vaccine - Prevents Polio
Name two live vaccines
Varicella and MMR (Mumps/Measles/Rubella)
When is Varicella vaccine given?
When is MMR given?
at 1 yr and 4 yrs
When is MMR vaccine contraindicated?
- In pregnant women
- Pts. allergic to Neomycin
4 Points to remember about vaccination:
- 2 vaccines can be given in the same extremity
- They can be administered even if the child has:
- Low grade fever
- Had recent exposure to an infectious disease
- Is taking antibiotics
How is Varisella (Chickenpox) spread?
Direct contact w
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