PNEUMONIA Clinical Features incidence is greatest in first year of life fever, cough, crackles tachypnea, tachycar...
PNEUMONIA
Clinical Features
- incidence is greatest in first year of life
- fever, cough, crackles
- tachypnea, tachycardia, respiratory distress
- bacterial cause has more acute onset, but viral cause is more common
- abnormal chest x-ray
Etiology
Management
- supportive treatment: hydration, antipyretics, humidified oxygen
- IV or PO antibiotics
- newborn
- ampicillin and gentamicin +/– erythromycin
- 1-3 months
- ampicillin +/– erythromycin
- 3 months - 5 years
- sick: IV ampicillin
- not sick: PO amoxicillin
- > 5 years
- erythromycin
ASTHMA
- characterized by airway hyperreactivity, bronchospasm and inflammation, reversible small airway obstruction
- very common illness which presents most often in early childhood
- associated with other atopic diseases such as allergic rhinitis or eczema
Clinical Features
episodic bouts of
- wheezing
- cough: at night, early morning, with activity
- tachypnea
- dyspnea
- tachycardia
Triggers
- URI (viral or Mycoplasma)
- weather (cold exposure, humidity changes)
- allergens (pets), irritants (smoke), cold dry air
- exercise, emotional stress
- drugs (aspirin, ß-blockers)
Classification
o mild asthma
• occasional attacks of wheezing or coughing (< 2 per week)
• symptoms respond quickly to inhalation therapy
o moderate asthma
• more frequent episodes with symptoms persisting and chronic cough
• decreased exercise tolerance
o severe asthma
• daily and nocturnal symptoms
• frequent ER visits and hospitalizations
Management
Acute
• oxygen: to keep oxygen saturation > 92%
• fluids: if dehydrated
• ß2-agonists: salbutamol (Ventolin) 0.03cc/kg in 3cc NS q 20 minutes by mask until improvement, then masks q hourly
• ipatropium bromide (Atrovent) if severe: 1 cc added to Ventolin mask
• steroids: Prednisone 2mg/kg in ER, then 1 mg/kg po od x 4 days
• in severe disease, give steroids immediately since onset of action is slow (4 hours)
Indications for hospitalization
• initial oxygen saturation < 92%
• past history of life-threatening asthma (ICU admission)
• poor response to 5-6 frequent doses of Ventolin
• concern over environmental issues or family’s ability to cope
Chronic
• education, emotional support, modification of environmental allergies or irritants (e.g. cigarette smoke)
• exercise program (e.g. swimming)
• monitoring if appreciation of symptoms is poor (e.g. peak flow meter)
• PFTs > 6 years old
• patients with moderate or severe asthma will need regular prophylaxis in addition to bronchodilators (e.g. inhaled steroids,sodium cromoglycate)
