Top cause of croup
Parainfluenzae 1-3 (barking parrot on steroids)
Age range of croup
6 months - 6 years
Risk factors (3)
- Age (6 months to 6 years)
- Smoke exposure (double risk)
- Narrowed airways e.g. instrumentation at delivery, ventilation (prematurity), airway hemangioma
Main treatment of croup
Steroids, PO or nebulised for a few days.
Can also give nebulised adrenaline
Top cause of bronchiolitis
RSV (bronchiolitis = respiratory (syncytial) virus)
Age range of bronchiolitis
Less than 12 months old, usually
Risk factors for bronchiolitis (2)
- Younger age
2. Parental smoking/in the home
1-2day prodrome of viral symptoms which deteriorates,
Followed by cough, wheeze, tachypnea, indrawing of chest, fever, decreased feeding.
Bronchiolitis
Viral prodrome symptoms, Noisy and rapid breathing Hoarse voice Inspiratory stridor Cough
Croup
barking cough
Pharmacological Rx of bronchiolitis?
NONE!!
Bronchodilators and corticosteroids do not usually help.
Management of bronchiolitis that doesn’t require admission (4)
Rest
Small feeds more often
No smoking
Avoid contact with other babies in first few days
What management for bronchiolitis requires admission (2)
Oxygen (hypoxic)
IV or NG fluids
Emergency management of asthma attack
4x4x4
- 4 puffs (for each: give 1 puff and breathe in/out 4x)
- After 4 puffs, wait 4 minutes
- Repeat
- If have to do more than 2x with no improv, call 000
If unsure asthma attack or anaphylaxis, which do you give first?
Adrenaline/EpiPen
Asthma: SABA?
Salbutamol
Asthma: LABA?
Salmeterol, Eformoterol
Asthma: ICS?
Budenoside, Fluticasone
Asthma: leukotriene antagonist
Montelukast
Asthma: reliever
SABA, salbutamol
Asthma: preventer
corticosteroids
“prevent long term conseq and future attacks”
Asthma: symptom controller
LABA, eformoterol
“like a SABA it controls the attack”
Signs of increased work of breathing
Head bobbing Nasal flaring Grunting Tracheal tug Intercostal recession Subcostal recession Subcostal notching Abdominal muscle use
Ix for bronchiolitis (if needed?)
NPA
Natural history of bronchiolitis
Get worse before they get better
Sick for 3-5 days (worst on day 2-3)
Then recover over next 7-10 days
Cough may continue for 2-4 weeks
