RESPIRATORY PAEDIATRICS Dr Pamela Lewis

6yr Male Emergency Department Sudden onset wheeze and DIB Preceding URTI Atopic Interval symptoms

Acute Asthma Assessment of severity Talking Respiratory rate Accessory muscle use Heart rate Oxygen saturations Peak Flow

Acute Asthma Management ABC and Oxygen B2 Agonist (LVS or Neb) Steroids (oral prednisolone/iv hydrocortisone) Ipratropium bromide neb Aminphyline/iv salbutamol Magnesium sulphate

Asthma- Chronic Management Interval symptoms and exacerbations Adherence Inhaler and spacer technique Growth Examination PF FEV1/FVC Medication BTS stepwise approach

3 month Female Emergency Department Cough, coryza, fever and poor feeding Preterm 25/40, oxygen until 6 wks of age Parental smoking Respiratory distress with bilateral crackles and wheeze

Bronchiolitis assessment Feeding (<50%) RR (>70) Nasal flare, grunting,recession Oxygen sats <92% History of apnoeas

Bronchiolitis Management Oxygen Fluids Consider blood investigations if diagnosis in doubt or severe CXR not routine In deterioration CPAP/IPPV Palivixumab prophylaxis for risk groups

10 Yr Male Emergency Department 2 days cough, fever> 39, abdominal pain and rigors No prior respiratory history HR 130 Refill 3 seconds BP 100/60 RR 36 dull to PN right base with crackles

Pneumonia Management ABC and Oxygen Fluids Antibiotics CXR BC FBC Electrolytes Sputum culture Complications Empyema, SIADH

4 yr Female Emergency Department Temperature 40, marked respiratory distress, soft stridor, drooling Unvaccinated

Epiglotitis SHOUT FOR HELP Senior anaesthetist, paediatrician, ENT Rapid sequence induction of anaesthesia Antibiotics ceftriaxone (Hib)

Childrens Outpatients 6 month Male Recent arrival in UK ( Europe) FTT Recent right upper lobe pneumonia Loose stools, good appetite Examination, weight < 0.4 th (BW 50 th ) cough and mild i.c recession

Cystic Fibrosis AR chromosome 7, CFTR defect,DF508 UK 1:2500, gene carrier 1:25 Multi organ involvement Respiratory: decreased mucocilliary clearance, diminished local defences and increased bacterial adherence, progressive loss of respiratory function

CF Diagnosis UK screening programme Heel Test at 6 days IRT Genetic testing CF mutations Sweat test Chloride > 60 (sodium < Chloride)

CF Management Multi disciplinary Infections prophylactic and treatment Nutrition Physiotherapy Psychology Screening for complications: liver, diabetes

Childrens Outpatients 3yr Female Refugee from Somalia Protracted cough, fevers, FTT Limited Family history no vaccination history CXR hilar lymphadenopathy and RUL collapse

TB Diagnosis Latent v Active TB Mantoux 6mm positive in those without prior BCG, >15mm positive in those with BCG Consider Gamma Interferon testing Sputum DON’T FORGET HIV

Treatment TB 6 month regime 2 months Rifampicin, isoniazid, pyrayinamide and ethambutol then 4 months rifampicin and isoniazid DOTS Public health and contact tracing