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What age range is most common for pediatric viral pneumonia?
between 1-5 years
(viral pneumonia more common than bacterial at that age)
What are the causative organisms for viral pneumonia?
RSV
parainfluenza
adenovirus
What are the clinical manifestations of viral pneumonia?
cough, fever, distress, SOB, coryza(inflammation of mucus membranes lining the nasal cavities; symptoms of a head cold)
Breath sounds associated with viral pneumonia?
wheezing, rhonchi
X-ray with viral pneumonia?
infiltrates, CONSOLIDATION
Diagnosis of viral pneumonia?
Nasal culture
Treatment of viral pneumonia?
Antiviral meds ASAP
Supportive therapy
*Oxygen
*CPAP
*Mech. Ventilation if severe
Mortality with Bacterial pneumonia?
Bacterial pneumonia results in higher mortality rate even though it is less common than viral.
Causative organism of bacterial pneumonia?
Streptococcus pneumonia (major cause for peds. > 5 years old)
Clinical manifestations of bacterial pneumonia?
Same as viral--cough, fever, disresss, SOB, etc.

Also--increased number of Bands
X-ray with bacterial pneumonia?
Same as viral--infiltrates, consolidation
Breath sounds with bacterial pneumonia?
Crackles, diminished
Diagnosis of bacterial pneumonia?
blood culture or sputum culture
Treatment of bacterial pneumonia?
Antibiotics ASAP
Supportive:
*Oxygen
*Mech. ventilation if severe
What is bronchiolitis?
VIRAL infection of the respiratory tract
*Inflammation of the bronchioles
Causative organism of bronchiolitis?
RSV (very contagious!)
Clinical manifestations of bronchiolitis?
Excessive secretions!
Cough, distress, periods of apnea, nasal congestion/drainage
What age group mostly gets bronchiolitis?
Mostly seen in peds. < 1 year
(nbrc says 3 mo.-3 years though)
What does the x-ray look like for bronchiolitis?
Hyperinflated, infiltrates, similar to pneumonia
What do ABGs look like with bronchiolitis?
moderate hypoxemia (because of secretions)
Treatment of bronchiolitis?
Supportive:
*Oxygen
*Keep hydrated
*Keep nares patent

RIBAVIRIN!
How often does Ribavirin run?
12-16 hours/day for 3-7 days

In a SPAG
Adverse affects of Ribavirin?
Eye irritation, nasal and throat irritation
Don't administer if pregnant or trying to get pregnant (can cause physical defects in embryo)

Wear protective equipment (gloves, mask, gown, neg. pressure room, etc.)
If giving Ribavirin through the ventilator, what should you do?
*Use extra filters, because can clog up filters
*Monitor PIP
*Always suction ETT often
What is epiglottitis?
Life threatening BACTERIAL infection!

Sudden acute inflammation (swelling) of epiglottis and structures above the glottis
What age range is most common for epiglottitis?
2-6 years old

(can be immunized from now)
Causative organism of epiglottitis?
Hemophilus influenza B.
Clinical manifestations of epiglottitis?
SUDDEN ONSET OF SYMPTOMS(2-6 hours)
High-grade fever
Severe sore throat
No cough
Muffled voice
Distress
May or may not have stridor
Diagnosis of epiglottitis?
Get an x-ray if possible (But want them to remain calm so they don't lose their airway!)
LATERAL neck x-ray
What defining feature will be on the x-ray?
Look for the "thumb sign" (epiglottis looks like a thumb because it's very swelled)
Treatment of epiglottitis?
FIRST--establish airway (if x-ray confirms diagnosis)
*May need to intubate (in a controlled situation only)

Then:
antibiotics

Inflammation will only last 36-48 hours
What is croup?
Laryngotracheal bronchitis

VIRAL infection

Swelling of structures BELOW the glottis (trachea, bronchi)
What age group mostly gets croup?
3 months-3 years most common
What is the causative organism of croup?
parainfluenza virus
Clinical manifestations of croup?
GRADUAL onset of symptoms (1-2 days)
INSP. STRIDOR
BARKY COUGH
low grade fever
How is croup diagnosed?
Neck x-ray AP VIEW
What are you looking for on an x-ray with croup?
Looking for "steeple sign" or hour glass shape--narrowing of trachea at top or middle
How do you treat croup?
Supportive:
*Cool mist aerosol
*O2
*Monitor them

RACEMIC EPINEPHRINE (local vasoconstrictor--to shrink swelling)(too much can cause rebound effect though!)
Possibly ICS (Pulmicort)
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