NR 602 Rotavirus Quiz Guide

Rotavirus

Croup

Viral infection of the middle respiratory track (Larynx and bronchial tree
Laryngotraceitis / Laryngotracheobronchitis (LTB)
- Viral: parainfluenza type 1 & 2 (HPIV)
- LTB more severe, occurs 5 – 7 days in to the disease
Usually children < 6 yrs
Season: fall and winter
Incubation period: 2-4 days with viral shedding up to 1 week, lasts approx. 5 days
HALLMARK: Barking Cough *Sound bit: 1, 2, 3 (https://mommyhood101.com/croup-audio-clips
Diagnosis: made by symptoms/clinical presentation
Symptoms:
- Low grade fever
- URI symptoms- gradual onset (rhinorrhea, congestion)
- Barking Cough
- Hoarseness
- Dyspnea
- Respiratory Distress (Intercostal retraction, tachypnea, cyanosis, accessory muscles, nasal flaring)
Clinical Findings:
- Tachypnea
- Prolonged inspiration
- Inspiratory stridor (as airway obstruction worsens) *Sound bit: 4, 5 (https://mommyhood101.com/croup-audio-clips)
- Wheezing (if lower airway involved)
- Chest X-Ray (not typically done): subglottic narrowing – Steeple Sign
Treatment:
- Supportive Care: Symptom Management
  - Cold air
  - Hydration
- Glucocorticoids: reduce airway swelling
  - Dexamethasone 0.6 mg/kg to1 mg/kg IM PO
- Aerosolized racemic epinephrine: reduce swelling of larynx and subglottis
- Bronchodilator
- Hospitalization:
  - RR > 70 bpm
  - Stridor at rest
  - Temperature > 102.2 F (39C)
- Complications:
  - Pneumonia
  - Respiratory distress

Epiglottitis

Inflammation of epiglottis, aryepiglottic folds, and ventricular bands at the base of the epiglottis
Cause: influenza type B (HiB)
Prevention: HiB vaccine
Typically age 1-5 yrs (most under 2 yrs)
Symptoms:
- Abrupt onset fever
- Severe sore throat
- Dyspnea
- Inspiratory distress without stridor
- *drooling
- Toxic look
Clinical Findings: Emergent- Death within hours
- * If epiglottitis is suspected: do NOT examine throat, do NOT place in supine position, Immediately transfer to ER
- Expiratory stridor
- Drooling
- Aphonia (muffled, ‘hot potatoe’ voice)
- Rapid progression of respiratory obstruction
- High fever
- Flaring ala nasi and retraction of supraclavicular, intercostals, and subcostal spaces
- Hyperextension of the neck
Diagnostic:
- Blood culture
- Lateral neck radiograph: absence of ‘thumb’ sign rules out condition
- Confirmed in OR
Treatment:
- Establish airway (possible intubation or tracheostomy)
- Start antimicrobials IV broad spectrum
  - Rifampin prophylaxis to all household members (20 mg/kg, max: 600 mg, x 4 days)
- O2/ respiratory support

NR 602 Rotavirus Quiz Guide

Foreign Body Occlusion/ Aspiration

Nasal Occlusion

Symptoms:
- Recurrent, unilateral purulent nasal discharge
- Foul odor
- Epistaxis
- Nasal obstruction/ mouth breathing
Detection of FB in nasal passageway
Removal:
- Alligator forceps
- Suction with narrow tips
- Cotton tipped applicators w/ or w/o topical vasoconstrictor
- Hook or curette
- 5-Fr catheter balloon inflation behind FB
- Refer to ENT

Laryngeal FB Aspiration

Tracheal FB Aspiration

Bronchial FB Aspiration

Symptoms:
- Unilateral wheeze, usually aspirated into *Right lung
- Recurrent pneumonia
- HX of Choking episode
Clinical Findings:
- Cyanosis
- Hemoptysis, blood streaked sputum
- Decreased vocal fremitus
- Limited chest expansion
- Diminished breath sounds
- Unilateral wheezes
  - Tracheal: homophonic wheeze: wheeze with audible ‘slap’ and palpable ‘thud’ on expiration
- Diagnostic:
  - Inspiratory and forced expiratory chest radiographs
  - Chest fluoroscopy
- Treatment: Referral to Pulmonary Specialist
- Complications:
  - If vegetable matter: severe condition
    - Fever, sepsis-like sxs, dyspnea, cough
  - Lobar pneumonia
  - Status asthmaticus
  - Emphysema, atelectasis
- Prevention: Education on high risk foods/objects:
  - Carrots, nuts, popcorn, hot dog chunks
  - Small toys, coins, buttons, etc

NRS 410 CLC Assignment: CHF Exacerbation and Increased Dyspnea