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PNEUMONIA and ASTHMA ( Pediatrics )

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PNEUMONIA


Clinical Features

 

  1. incidence is greatest in first year of life
  2. fever, cough, crackles
  3. tachypnea, tachycardia, respiratory distress
  4. bacterial cause has more acute onset, but viral cause is more common
  5. abnormal chest x-ray

Etiology

 

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Management

 

  1. supportive treatment: hydration, antipyretics, humidified oxygen
  2. 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

 

  1. characterized by airway hyperreactivity, bronchospasm and  inflammation, reversible small airway obstruction
  2. very common illness which presents most often in early childhood
  3. associated with other atopic diseases such as allergic rhinitis or eczema


Clinical Features


episodic bouts of

 

  1. wheezing
  2. cough: at night, early morning, with activity
  3. tachypnea
  4. dyspnea
  5. tachycardia

 

Triggers

 

  1. URI (viral or Mycoplasma)
  2. weather (cold exposure, humidity changes)
  3. allergens (pets), irritants (smoke), cold dry air
  4. exercise, emotional stress
  5. 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)

PNEUMONIA and ASTHMA ( Pediatrics ) PNEUMONIA and ASTHMA ( Pediatrics ) Reviewed by Radiology Madeeasy on October 05, 2010 Rating: 5
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