3The most important sign: Tachypnea Cut off rate per minuteLess than 1 week up to 2 months: 60 or more2 months up to 12 months: 50 or more12 months up to 5 years: 40 or more.Pathophysiology:HypoxaemiaPulmonary oedemaParenchymal inflammationRestricitve/obstructive diseases
4The most severe sign: Apnoea Acute life threatening event:Apnoea > 20 second or associated with pallor, cyanosis, convulsion or limpness.Aetiology:PrematuritySepsisMeningitis/encephalitisDrugsAbnormal muscle tone
5Cough Commonest respiratory symptom. Physiological to remove excess secretions or foreign body.Cough receptors in the posterior pharynx and large bronchi.Vagus/ glossopharyngeal: afferent to cough centre –pons /medulla. Efferent to - larynx/ diaphragm/ chest wall/abdominal wall/pelvicAcute: lasts less than 2 weeks.Chronic: lasts more than 2 weeks.
6Cough relating to time/ posture During or after feeding: aspirationNight: asthma/ post nasal dripMorning: bronchiectasisWith exercise: asthmaAbsence during play: psychogenicSeasonal: allergenCold: hyperreactivity
8Treatment of chronic cough Over the counter cold preparation:no beneficial effect in children under 5 years.Post nasal drip:Propped up position at 30 degree.Treat accordingly for Allergic/non allergic rhinitis; SinusitisMacrolides: if Mycoplasma / chlamydia suspected.Nasal steroids/ decongestantBronchodilators/ steroidsSpecific treatment
9Psychogenic Cough School aged children. The child is often a high achiever; family stressFixed timing but disappears during sleep and when distracted.Diagnosis by observation and exclusion of other causes.Treatment: Counseling, Normal saline gargle
12Stridor Inspiratory harsh sound continuously. Can occur during expiration (intrathoracic) or both phase of respiration.Asses the severityDrooling of saliva, respiratory distress, unable to swallow, cyanosisCommon causes:Infective: epiglottitis, laryngotracheobronchitis, tracheitis, retropharyngeal abscess (rare)Malignancy: tumor compression, papillomaAllergic: angioneurotic oedema.Congenital: laryngomalacia, laryngeal web, vascular ring,Aspiration: foreign body.Neuronal: paralysis of vocal cord.InvestigationBlood count; Lateral neck X-ray; flexible bronchoscopy.
13Grunting Low pitched expiratory sound. Protective phenomenon to prevent collapse of alveoli: PEEPCauses:Respiratory distress syndromeSevere pneumonia, ARDS, severe sepsisInvestigations:CXR; O2 saturation, blood gas
14A child who wheezes: All wheezes are not Asthma Cough could be the only symptom.Triggering factorWorse at nightHistory of repeated problem.Symptomatic improvement with bronchodilator.Gastro-esophageal reflux: Prokinetic.
15Causes of Wheeze/Ronchi BilateralAsthmaBronchiolitisMycoplasmaCystic fibrosisAlpha 1 antitrypsin deficiencySevere pneumoniaUnilateralPneumoniaForeign bodyMediastinal massTuberculosisBronchiectasisVascualr ring
17The severe signs: Chest Indrawing and Cyanosis Increased airway resistance.Contraction of diaphragm and pulling of ribs inside.Negative pressure insideBreathing in and lower chest wall goes in.Supra sternal, inter costal recession.Cyanosis:Vasomotor instability in acrocyanosis.Defective perfusion.Defective ventilation.Defective diffusion.MethhaemoglobinemiaHyperoxia test
18Haemoptysis: not common Blood from posterior naso-pharynx or hematemesis: the difference.Aetiology:Bronchiectasis.Severe coughPneumoniaParagonimiasisForeign bodySevere measlesHaemangioma/ AV malformation