Pediatric Acute Care – Pulmonology Study Notes
acute laryngotracheobronchitis (CROUP) - correct answer Peak 6 months to 3 years. Viral.
PARA FLU, ADENOVIRUS, RSV
Xray are not to document
the diagnosis but rather to exclude other,
more serious, causes of upper airway obstruction
that require intervention. Best seen on frontal xray. inverted V or a church steeple
laryngotracheobronchitis (croup) LTB - correct answer effects of Dexamethasone 0.6mg/kg
steroids can be seen within 6 hours
Diff from epiglottis = history of URI symptoms, barking cough*
Peds: narrowest airway is at cricotracheal junction.
laryngotracheobronchitis (CROUP) - correct answer Subglottic airway- larynx, trachea, and
bronchi
High in 3 months to 3 yrs. Parainfluenza** Symptoms can last for up to 1 week .
Tx: Humidified air, fever control, one time dose of Dexamethasone 0.6mg/kg. Nebulized epineb.
(0.5ml of2.25% in 3 ml of NS)- at risk for rebound for 4 hours post neb. Heliox 70-30 (improves
laminar air flow through narrow airway)
Epiglotitis - correct answer Hemophilus influenzae a
paraflu, H flu ( nontypable) GAS, strep Pneumo
toxic appearing.
abrupt stridor, dysphagia, fever, restlessness
The patients are typically
older than those with croup; the classically
described peak incidence occurs at age 3.5. Obtain a Lateral radiography of neck will reveal a
large epiglottis with extension of the hypopharynx " thumb sign"
Epiglotitis - correct answer pending cultures: 7-10 day course of 3rd gen cephalosporin + or -
Vancomycin if MRSA is suspected.
,Epiglottis - correct answer H influenza * cases reduced since invention of vaccine. Less likely
causes : S.pneumo, s. aureus, B-hemo-strep.
AP lateral neck "thumb sign" at epiglottis.
Exudative tracheitis - correct answer purulent infection of the trachea
in which exudative plaques form along the tracheal
walls (much like those seen in diphtheria).6 to 10 years. Staph areus
Hemangioma - correct answer Facial hemangiomas in the
"beard" distribution have been associated symptomatic
airway hemangiomas, which should raise the
providers concern for airway compromise
Subglottic stenosis - correct answer 3rd most common anomaly of larynx. Males*
small cricoid cartilage with associated thickening of sub mucous layer.
PE: May be NO sx until URI or cold. Stridor and barking cough. Often diagnosed with chronic
laryngotracheobronchitis (CROUP).
** recurrent croup** red flag
Dx made if lumen is < 4mm in term infant.
Tx: Balloon dilation, tracheostomy, rib plasty.
laryngomalacia - correct answer most common cause of stridor and congenital abnormality of
larynx* males* Not necessarily in prematurity
symptoms are absent at birth, arise @ 2-4w. inspiratory stridor worse when supine* poor
feeding, GERD, Pt has normal cry and rarely respiratory distress.
Dx: Awake laryngoscopy= elongated and laterally extended omega epiglottis, that falls
posteriorly on itself on inspiration. **collapse of aryepiglottic folds on inspiration** 15 % will
require trach. co-existing GERD worsens patho.
Tx: Acid reflux precautions, OR for epiglottoplasty ( dividing aryepiglottic folds and trimming
epiglottis)
Tracheomalacia - correct answer trachea is floppy. collapsing during inspiration and expiration.
Primary ( deformity of tracheal rings) secondary (vascular rings, TE fistula repair).
PE: stridor, wheeze, barking cough. "drying spells" - reflex apnea with Cardiac arrest
, Vocal cord paralysis - correct answer 2nd most common cause of larynx anomaly.
unilateral (trauma) or bilateral (CNS dx). May spontaneously resolve by 2 yrs. Asymptomatic
unless agitated.
Associated with Arnold Chiari, meningomyelocele, hydrocephalus, birth trauma.
PE: weak cry, biphasic stridor, aspiration, feeding difficulty.
Tx: Tracheostomy
Retropharyngeal cellulitis - correct answer pyogenic infection
of the retropharyngeal space that usually follows
a recent pharyngitis or upper respiratory tract
infection. Children present with sudden onset fever, stiff neck, dysphagia, and occasionally
stridor. PEAK : 6-12 months of age. On lateral radiography,
there is thickening of the retropharyngeal soft
tissues. The only radiographic feature
that can differentiate abscess from cellulitis is
the identification of gas within the retropharyngeal
soft tissues
Retropharyngeal and peritonsillar abscess - correct answer Polymicrobial (Strep pyrogens, S.
aureus, and Haemophilus)
P: unilateral pain, trismus, neck swelling, muffled speech. Vanc and linezolid pending cultures x
14 days.
Large may require I and D.
Bacterial Tracheitis - correct answer bacterial invasion of larynx, trachea, or bronchi.
mucopurulent pseudo membranes = narrowing airway. Fall and winter*. S Aureus, MRSA,
Moraxella, H. influenza b. seen with current or recent viral infection.
- acute high fever, toxic, high WBC, stridor, croup sx, lower airway symptoms are usually
associated with concurrent viral infection.
Plan: obtain lateral (narrowing or hazy trachea) to rule out PTA, croup and epiglottis.
Tx: Broad spectrum coverage for Staph, Strep, Moraxella, and Haemophilus :
acute laryngotracheobronchitis (CROUP) - correct answer Peak 6 months to 3 years. Viral.
PARA FLU, ADENOVIRUS, RSV
Xray are not to document
the diagnosis but rather to exclude other,
more serious, causes of upper airway obstruction
that require intervention. Best seen on frontal xray. inverted V or a church steeple
laryngotracheobronchitis (croup) LTB - correct answer effects of Dexamethasone 0.6mg/kg
steroids can be seen within 6 hours
Diff from epiglottis = history of URI symptoms, barking cough*
Peds: narrowest airway is at cricotracheal junction.
laryngotracheobronchitis (CROUP) - correct answer Subglottic airway- larynx, trachea, and
bronchi
High in 3 months to 3 yrs. Parainfluenza** Symptoms can last for up to 1 week .
Tx: Humidified air, fever control, one time dose of Dexamethasone 0.6mg/kg. Nebulized epineb.
(0.5ml of2.25% in 3 ml of NS)- at risk for rebound for 4 hours post neb. Heliox 70-30 (improves
laminar air flow through narrow airway)
Epiglotitis - correct answer Hemophilus influenzae a
paraflu, H flu ( nontypable) GAS, strep Pneumo
toxic appearing.
abrupt stridor, dysphagia, fever, restlessness
The patients are typically
older than those with croup; the classically
described peak incidence occurs at age 3.5. Obtain a Lateral radiography of neck will reveal a
large epiglottis with extension of the hypopharynx " thumb sign"
Epiglotitis - correct answer pending cultures: 7-10 day course of 3rd gen cephalosporin + or -
Vancomycin if MRSA is suspected.
,Epiglottis - correct answer H influenza * cases reduced since invention of vaccine. Less likely
causes : S.pneumo, s. aureus, B-hemo-strep.
AP lateral neck "thumb sign" at epiglottis.
Exudative tracheitis - correct answer purulent infection of the trachea
in which exudative plaques form along the tracheal
walls (much like those seen in diphtheria).6 to 10 years. Staph areus
Hemangioma - correct answer Facial hemangiomas in the
"beard" distribution have been associated symptomatic
airway hemangiomas, which should raise the
providers concern for airway compromise
Subglottic stenosis - correct answer 3rd most common anomaly of larynx. Males*
small cricoid cartilage with associated thickening of sub mucous layer.
PE: May be NO sx until URI or cold. Stridor and barking cough. Often diagnosed with chronic
laryngotracheobronchitis (CROUP).
** recurrent croup** red flag
Dx made if lumen is < 4mm in term infant.
Tx: Balloon dilation, tracheostomy, rib plasty.
laryngomalacia - correct answer most common cause of stridor and congenital abnormality of
larynx* males* Not necessarily in prematurity
symptoms are absent at birth, arise @ 2-4w. inspiratory stridor worse when supine* poor
feeding, GERD, Pt has normal cry and rarely respiratory distress.
Dx: Awake laryngoscopy= elongated and laterally extended omega epiglottis, that falls
posteriorly on itself on inspiration. **collapse of aryepiglottic folds on inspiration** 15 % will
require trach. co-existing GERD worsens patho.
Tx: Acid reflux precautions, OR for epiglottoplasty ( dividing aryepiglottic folds and trimming
epiglottis)
Tracheomalacia - correct answer trachea is floppy. collapsing during inspiration and expiration.
Primary ( deformity of tracheal rings) secondary (vascular rings, TE fistula repair).
PE: stridor, wheeze, barking cough. "drying spells" - reflex apnea with Cardiac arrest
, Vocal cord paralysis - correct answer 2nd most common cause of larynx anomaly.
unilateral (trauma) or bilateral (CNS dx). May spontaneously resolve by 2 yrs. Asymptomatic
unless agitated.
Associated with Arnold Chiari, meningomyelocele, hydrocephalus, birth trauma.
PE: weak cry, biphasic stridor, aspiration, feeding difficulty.
Tx: Tracheostomy
Retropharyngeal cellulitis - correct answer pyogenic infection
of the retropharyngeal space that usually follows
a recent pharyngitis or upper respiratory tract
infection. Children present with sudden onset fever, stiff neck, dysphagia, and occasionally
stridor. PEAK : 6-12 months of age. On lateral radiography,
there is thickening of the retropharyngeal soft
tissues. The only radiographic feature
that can differentiate abscess from cellulitis is
the identification of gas within the retropharyngeal
soft tissues
Retropharyngeal and peritonsillar abscess - correct answer Polymicrobial (Strep pyrogens, S.
aureus, and Haemophilus)
P: unilateral pain, trismus, neck swelling, muffled speech. Vanc and linezolid pending cultures x
14 days.
Large may require I and D.
Bacterial Tracheitis - correct answer bacterial invasion of larynx, trachea, or bronchi.
mucopurulent pseudo membranes = narrowing airway. Fall and winter*. S Aureus, MRSA,
Moraxella, H. influenza b. seen with current or recent viral infection.
- acute high fever, toxic, high WBC, stridor, croup sx, lower airway symptoms are usually
associated with concurrent viral infection.
Plan: obtain lateral (narrowing or hazy trachea) to rule out PTA, croup and epiglottis.
Tx: Broad spectrum coverage for Staph, Strep, Moraxella, and Haemophilus :
