PEDIATRICS 2 Treatment

Topic: Respiratory Tract Disorders o AAP (recommended antimicrobial

Lecturer: Dra. Ma. Cristina Edquilag treatment)
o Amoxicillin 45 mkd
Complication
UPPER RESPIRATORY TRACT o Periorbital cellulites
DISORDERS IN CHILDREN o Intracranial complication
o Meningitis
ACUTE SINUSITIS
o Ethmoidal & Maxillary Prevention
 Present at birth o Handwashing frequently
 Only ethmoidal sinus is o Influenza vaccine (Feb-June)
pneumatized o Avoid persons with colds
o Maxillary
 Pneumatized after 4 years old ACUTE TONSILLOPHARYNGITIS
o Sphenoidal Sinus
 Present at 5 y/o Etiology and Epidemiology
o Frontal o Most Important Agents
 Develop by 7-8 y/o  Viruses
 Group A-beta hemolytic
Etiology & Epidemiology streptococcus
o Acute Bacterial Sinusitis  H. influenzae
 S. pneumoniae  S. pneumoniae
 H. influenzae o Spread by close contact
 M. catarrhalis o Streptococcal pharyngitis
 Occur at any age  Uncommon before age 2-3 years
 Predisposing condition: of age
- viral URTI o Incidence increases among children
- allergic rhinitis o Declines in late adolescence and
- cigarette exposure adulthood

Clinical Manifestation Clinical Manifestation

o Non-specific o Tonsillitis
o Nasal congestion  Prominent sore throat
o Nasal discharge  Fever
o Fever  Headache & GI symptoms
o Cough (frequent)
o Bad breath o Pharyngitis
 Odynophagia
Diagnosis  Dry throat
o Based solely on history  Malaise
o > 10 d URTI persistent Sx  Fever
o Nasal discharge  Chills
o Cough  Dysphagia
o Fever  Headaches
o Sinus aspirate Culture
 Enlarged lymph nodes
 Only accurate method of dx o Pharynx
 Not practical  Red
o Transillumination of the sinus cavities o Tonsils
 Unreliable in children  Enlarged, yellow, blood-tinged
o Radiographic studies exudates
 CT / Sinus plain films
  Petechiae or “doughnut” lesions
on the soft palate and posterior
pharynx
o Uvula
 Red, stippled and swollen
Diagn
osis
o The goal is to identify GABHS
 Throat culture (imperfect)
 Group A Streptococcus Rapid Test
(impractical)
 CBC ( to detect atypical
lymphocyte in EBV)
Treatment
o Early antibiotic therapy hastens
clinical recovery by 12- 24 hours
o Primary benefit of treatment is
prevention of rheumatic heart fever
o Antibiotics
 Penicillin V for 10 days
 Amoxicillin
 Benzathine – Penicillin G 600,000
IU TIM
 Azithromycin
 Erythromycin
CROUP
Clinical Manifestations
o Cold symptoms
o Barky cough
o Hoarseness
o Inspiratory stridor
o Respiratory distress
CROUP
o Most common in children ages 6
months to 2 years
o Parainfluenza types 1, 2 & 3
o RSV
o Incidence varies
o Imaging Lab Data
o X-RAY of neck: steeple sign
(narrowinfg in area of cricoid
cartilage)
o Leukocytosis is uncommon and if
present may suggest bacterial
tracheitis or epiglottitis
Treatment
o Aerosolized racemic epinephrine
o Steroids
EPIGLOTTITIS
Obstruction in epiglottis
Clinical manifestations
o Stridor
o High fever
o Drooling of saliva
o Dysphagia
o Toxic-looking patient
Diagnosis of Epiglottitis
o Lateral neck x-ray
o Thickened and bulging epiglottis
(thumb sign) and thickened
aryepiglottic folds
o Direct observation of a swollen red
epiglottis and inflamed supraglottic
structures (in a well staffed OR
including a surgeon and
anaesthesiologist)
Treatment
o Endotracheal intubation
o Antibiotics for 48-72 hours
LOWER RESPIRATORY TRACT
DISORDERS IN CHILDREN
BRONCHIOLITIS
Airway inflammation and
reactivity in young child (less than 2
years) with a viral cause (usually RSV)
Clinical Manifestations
o Rhinorrhea
o Sneezing
o Cough
o Fver
o Rapid breathing wheezing
Treatment Considerations
o Fluids
o Antipyretics
o Oxygen
o Temporary use of bronchodilators
o Steroids
BRONCHIOLITIS
o Relationship to asthma
o High incidence (30-50%) with
bronchiolitis during infancy
develop asthma
FOREIGN BODY ASPIRATION
o Occurs most commonly in children 6
6 months and 4 years of age
o Younger children usually aspirate
food, small toys, balloons, or other
small objects
Clinical Symptoms
o Cough
o Localized wheezing
o Unilateral absence of breath sounds
o Stridor
o Cyanosis
o Dyspnea
o Prolonged FB aspiration symptoms
include cough, fever, sputum
production or chest pain
Diagnosis
o History (witnessed aspiration)
o Physical Exam
o Radiologic study
 Air trapping on exhalation
on the side of the FB seen
on assisted expiratory or
lateral decubitus chest file
 Occasionally atelectasis
Treatment
o Prevention with education (tiny
toys, peanut, popcorn, hotdog,
balloons, nuts, anything)
o Bronchoscopy and removal
BRONCHIAL ASTHMA
o Inflammatory disorder of airways
o Symptoms
 Wheezing
 Shortness of breath
 Chest tightness
 Coughing
Epidemiology
o Most common chronic disease of
childhood
o 5 million children per year in US
under age 18
o Onset
 33% before 2 years of age
 80% before age 5
o Males out number females with
asthma in childhood
Clinical Symptoms
o Precipating Factors include:
 Viral infection
 Allergens (food inhalants)
 Exercise/Activity
 Chemicals
 Pollutants
 Environmental changes
 Emotions
 GER
 Sinusitis
 Drugs
Treatment
o Pharmacologic therapy
o Patient and family education
o Self-management skills for
adolescents
o Environmental control
IMMUNOTHERAPY (Allergy Shot)
New Option in the treatment of Allergic
Asthma
o Practice of administering gradually
increasing quantities of an allergen
extract to an allergic patient
o Aimed at decreasing sensitivity to
allergens
o Prevent progression from allergic
rhinitis to asthma
PNEUMONIA
o Inflammation of lung parenchyma
o A significant cause of mortality in
childhood
o 4 M deaths among children
worldwide
o Bacterial and viral causes are found
in 44-85% of children with CAP
o Most common combination of
pathogens:
 S. pneumoniae
 RSV
 Mycoplasma
o Peak attack rate for viral pneumonia
= between the age of 2 & 3
o RSV = the major pathogen for
children younger than 3 years
o For children older than 5 years
old:
  S. pneumoniae  Limitaion of chest excursion
 M. pneumoniae  Decreased o absent breath sound
 Crackles
Clinical Manifestations Diagnosis and Treatment
o Cough o Chest Radiography
o Fever  Establishes the diagnosis
o Labored breathing o Treatment depends on the cause of
 Tachypnea the collapse
 Retractions o Deep breathing
 Use of accessory muscles o Chest physiotherapy
o Changes in patient’s position
Diagnosis
o Chest radiograph (confirmatory) Direct Signs
o CBC (may be used to differentiate o Deviation of the fissure
bacterial from viral) o Crowding of the lung markings
o Viral isolation o Increase opacification
o Bacterial culture
 Blood Indirect Signs
 Pleural fluid o Shifting of the mediastinal structures
 Lung o Elevation of the diaphragm
o Narrowing of the rib interspaces
Treatment o Compensatory hyperinflation of the
o Treatment of suspected bacterial unaffected lung
pneumonia is based on the
presumptive cause and the HYDROTHORAX
clinical appearance of the child o Pleural effusion pneumothorax
 Amoxicillin o Transudate/exudates
 Macrolide o Loculated fluid accumulation
 Cefuroxime IV
 Vancomycin or Causes
clindamycin o Bacterial pneumonia
o Viral pneumonia o Most common cause
 Supportive o Heart failure
o Rheumatologic cause
ATELECTASIS o Malignancy
Incomplete expansion or complete
collapse of lungs Manifestations
o Results from obstruction of air o Pain
intake into alveolar sacs  Principal symptom
o Causes  Exaggerated by deep breathing ,
 Viral infection coughing and straining
 Trauma  Referable to the back or shoulder
 Asthma o Friction Rub
 Pneumonia o Decreased breath sound
 Tension pneumothorax
 Aspiration Diagnosis
o Chest Radiograph
 ………………
 ………………  Lateral decubitus
o Ultrasound
Clinical Manifestation o CT scan
o Symptoms vary with the cause and o Thoracentesis (diagnostic &
extent of atelectasis therapeutic)
o PE findings
Transudate vs Exudate 1. Ghon focus
o Clear vs cloudy 2. adenopathies
o Few leukocytes 3. lymphangitis
o CHON less than 3g/dl 4. Pleural effusion
o LDH < 200 IU
o pH > 7.2 REACTIVATION TB

Hydrothorax Treatment
o chest tube drainage
o Surgical decortication (for
inadequately treated empyema)
o Systemic antibiotics
 3-4 wks for staphylococcal
infection

PNEUMOTHORAX
o Accumulation of extrapulmonary
air within the chest
o Uncommon during childhood
o Primary
 Spontaneous
o Secondary
 Traumatic
 Iatrogenic
 Complication
 Pneumonia
 Abscess
 Rupture of cyst

Clinical Manifestations
o Depends on the extent
o Abrupt
o Respiratory distress
o Displacement of intrathoracic organs
o Decreased to absent breath sounds

Diagnosis
o Radiographic examination

Treatment
o Varies with the extent of collapse and
severity
o < 5% pneumothorax may resolve
spontaneously (within one week)
o Administering 100% oxygen may
hasten resolution
o Chest tube thoracotomy
o Treat the underlying pulmonary
disease

PTB

PRIMARY INFECTION