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<< Click here to get 40 Pulmonology questions straight from my book The Final Step >>
Acute bronchitis
- Infection of the large bronchi
-
Most often caused by a virus
- RSV
- Rhinovirus
- Influenza
- 5-10% are bacterial
- Usually follows a URI
Clinical Presentation
- Shortness of breath
- Cough can last for more than three weeks
- Wheezing
- Fever
Labs, Studies and Physical Exam Findings
- Prolonged expiration
- Wheezing or rhonchi
- X-ray showing hyperinflation of the lungs and rules out pneumonia
- Sputum Gram stain
Treatment
- H. flu vaccine
-
Supportive care
- Fluids
- Rest
- Use of humidifier
-
Medications
- Antibiotics are not typically used
- Acetaminophen
- Antitussive
- Albutoral
- Smoking cessation
Acute bronchiolitis
- Infection of the smaller airways known as the bronchioles
- Most commonly in children under two years old
-
Typically a viral infection
- Most commonly caused by respiratory syncytial virus (RSV)
- Adenovirus
- Influenza
- Parainfluenza
- Rhinovirus
Clinical Presentation
- Coughing
- Wheezing
- Dyspnea
- Decreased feeding
Labs, Studies and Physical Exam Findings
- Crackles
- Wheezing
- Elevated respiratory rate
- Chest wall retractions and accessory muscle breathing
- Nasal flaring
- Chest x-ray rarely used to rule out pneumonia
Treatment
- Supportive care
- Humidifier
- Fluids
- Nebulized albuterol or epinephrine
- Self limiting
Acute epiglottitis
- An inflammation of the flap of tissue which covers the trachea
- This is a medical emergency as it can lead to complete obstruction of the trachea
-
Often this is a bacterial infection but may be viral
-
Historically caused by Haemophilus influenzae B
- Vaccinations have decreased these infections substantially
- Streptococcus
- Staphylococcus
- Many other bacteria
-
Historically caused by Haemophilus influenzae B
Clinical Presentation
- Difficulty swallowing
- Severe sore throat
- Drooling
- Hoarseness
- Stridor
- Patient wants to sit up or even in move into tripod position
Labs, Studies and Physical Exam Findings
- Shallow respirations
- X-ray of – lateral neck film with thumbprint sign – enlarged epiglottis
-
Laryngoscopy is diagnostic
- This may lead to airway spasm and should be done in an OR setting
Treatment
-
Prevention
- H. Flu vaccination
- Endotracheal tube to make sure airway is patent
- Keep child calm and relaxed
- Oxygen
-
Antibiotics
-
Second or third generation cephalosporin
- Ceftriaxone
- Clindamycin or Erythromycin
-
Second or third generation cephalosporin
- Tracheostomy if necessary
Croup (Laryngotracheobronchitis)
- Most common age affected is six months to three years
- Usually occurs in the fall and winter
-
Most commonly a virus
- #1 Parainfluenza
- Respiratory syncytial virus
- Rhinovirus
Clinical Presentation
- Low grade fever
- Congestion
- *** Barking or seal like cough***
- Stridor
Labs, Studies and Physical Exam Findings
-
X-ray of neck and chest
- May show steeple sign (subglottic narrowing which may also may be a normal finding in up to 50% of children)
Treatment
- Supportive care
- Use of a humidifier
- Oral steroid
- Nebulized epinephrine for more severe cases
<< Click here to get 40 Pulmonology questions straight from my book The Final Step >>
