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Bronchiolitis : IMPORTANT 🆘 WHHEZE +LOW GRADE FEVER 🔑 (Pneumonia high grade fever) YOUNGER THAN 2 YEARS 🔑 STARTS WITH CORYZAL SYMPTOMS ➡️ COUGH +WHEEZE 🔑 Acute viral inflammatory illness of small airways that occurs in winter epidemics and affects aged <2 yr 🔑, with peak incidence at around 6 months 🥇🥇 The most common cause of wheezing in infants RSV (most common) , other viruses also could be causative C.F Coryzal symptoms for 2–5 days before presentation Cough (sometimes paroxysmal) Irritability and poor feeding Mild pyrexia – rarely >38.5°C 🔑 Chest examination reveals : WHEEZING 🔑 as the most prominent feature with tachypnea, nasal flaring and retractions. Auscultation usually reveal overt WHEEZE with prolongation of expiratory phase +/_ fine crackles. Diminished breath sounds suggest very severe disease with nearly complete bronchiolar obstruction. DX : Bronchiolitis is mainly a Clinical Dx, especially in previously healthy infant presenting for the 1st time during community outbreak. CXR may show hyperinflation of lungs with patchy atelectasis. CBP is usually normal. INDICATIONS FOR ADMISSION 🆘 🔑 VIP_S T O R M – 6 V :Vomiting and diarrhoea I : Immunodeficiency P: Parents noncompliant S : sever distress T : Toxic O : Oxygen need R: Respond Absent to medical therapy M: Medical risks ( pre_ existing lung or cardiac disease) 6 : younger than 6 months Supportive therapy is the mainstay include: Cool humidified oxygen Good hydration Suction of secretions, & putting the infant in a semisitting position Nebulization can be done with any of the following agents:- 1. β-agonists e.g. salbutamol; it is effective when there is a component of bronchial hyper-reactivity (asthma). Otherwise, the response is unpredictable, therefore observe the response objectively. 2. Epinephrin may be more effective as bronchodilator than β-agonists , not routinely used. 3. Steroid inhalation e.g. budesonide may be indicated in hx of atopy (food allergy, eczema). Hypertonic Saline nebulization & Heliox inhalation have also some benefit in bronchiolitis.✅✅✅ Ribavirin by nebulization may be used for bronchiolitis due to RSV in infant who had other chronic lung or heart disease; whereas other antiviral agents (including palivizumab) antibiotics have no role in Rx of bronchiolitis.

1- Unilateral posterior pharyngeal Swelling 2-Marked widening of the pre-vertebral soft tissue between C2 and C7 on lateral Xray

4- Retropharyngeal abscess: YOUNGER THAN 4 years 🔑 NECK STIFFNESS, TORTICOLLIS 🔑 STRIDOR 🔑 younger than 3-4 yr; Retropharyngeal VANISHED ❌ after 5 yr of age. Fever, irritability , NECK🔑 stiffness, and TORTICOLLIS 🔑. Drooling, stridor, respiratory Distress , Decreased oral intake Unilateral posterior pharyngeal Swelling Marked widening of the pre-vertebral soft tissue between C2 and C7 on lateral Xray RX : IV antibiotics ➕/➖ surgical drainage. A third-generation cephalosporin combined with ampicillin-sulbactam or clindamycin .

TODDLER , OLDER INFANTS 🔑 Sudden CHOKING, GAGGING 🔑 + HX OF FB 🔑

3- FOREIGN BODIES IN THE AIRWAY TODDLER , OLDER INFANTS 🔑 CHOKING , GAGGING (sudden) 🔑 فجأة يجي يغصغص بدون سابق انذار + HISTORY by a witness 🔑 Older INFANTS 🔑 and TODDLERS🔑 use their mouths to explore their surroundings; therefore, they are the most common victims. FBs are mainly lodged in the right main bronchus‼️ C.F Three stages of symptoms may result from aspiration of FB into the airway:- 1. Initial event; paroxysms of coughing, CHOKING 🔑& GAGGING 🔑immediately after FB aspiration. 2. Asymptomatic interval; the FB becomes lodged; reflexes fatigue, irritating symptoms subside, may cause delay in Dx. ممكن تسبب تاخير بالتشخيص بعد ما تروح اعراض الاختناق المفاجئ‼️ 3. Complications; due to obstruction, erosion, or infection . والعلامات السريرية ممكن تحتلف حسب مكان استقرار الجسم Laryngeal foreign body: Complete obstruction of air ways may asphyxiates the child 🆘 وجوده بالحنجرة قد يسبب غلق كامل للمجاري التنفسية العليا وبحال صار غلق كامل تنتقل مباشرة لاحد المنوفرات الخاصة وحسب عمر الطفل immediate resuscitations done ( Heimlich maneuver done for those more than 1y , in younger  infant back blows and chest thrusts used). Tracheal foreign body: choking and aspiration occur almost universally . Stridor in 60% wheezing in 50%, that is usually unilateral and associated with decreased breath sounds. Bronchial foreign body: obstructs the exit of air from lung during expiration, producing obstructive emphysema (air trapping). ➕➕Positive History by witness must never be ignored, ➖➖Negative hx should not exclude the diagnosis . Investigations: CXR may be normal if taken in inappropriate way or the FB is radiolucent ❌. should be taken in both A-P & lateral views and during deep expiration. Fluoroscopy, CT, & MRI are more diagnostic. Bronchoscopy is both diagnostic & theraputic.✅✅✅ Rx : Laryngeal FB can sometimes be dislodged by upside-down in infants, or Heimlich maneuver in children, otherwise should be removed by direct Laryngoscope. Tracheal & Bronchial FB should removed urgently by rigid bronchoscope.

GOLDEN KEYS 🔑 THUMB PRINT SIGN 🔑 DROOLING +MUFFLED SPEACH 🔑 TOXIC PATIENT 🔑 DROOLING , DYSPHAGIA ,DYSPNEA 🔑

2-Epiglottitis 🆘 STRIDOR + TOXIC + MUFFLED sound 🔑 THUMB print sign 🔑 Drooling + Dysphagia + Distress (3D) 🔑 NECK hyperextended 🔑 t is a dramatic, life-threatening condition. ‼️🆘 Acute potentially fulminating course of high fever, sore throat, dyspnea, and RAPIDLY 🆘progressing respiratory obstruction. Was mainly caused by Haemophilus influenzae type B , the widespread use of H. Influenzae reduce the condition by almost 90% C.P : Peak age ≈ 3 yr. (between 2 and 6) Sudden as fever & sore throat Patient within hours become TOXIC 🔑 مهم للتفريق عن باقي اسباب الstridor .. TOXIC Dyspnea , open mouth, Muffled sound🔑 Tripod sitting, dysphagia & drooling of saliva🔑 Strider is a late finding and suggests near-complete airway obstruction. INV : اتجنب القيام بأي اجراء ممكن يسبب anxiety لحدما تسوي airway secure Venepuncture ❌ Try to see the epiglottis by tongue depressor❌ MAY AGGRAVATE THE CONDITION 🆘🆘 SHOULD be avoided until airway is secured ✅✅ X-ray of neck in lateral view with neck hyperextended may show the "THUMB SIGN " of epiglottis.🔑🔑 Laryngoscope should only be done in the operating room 🆘🆘🆘 Shows : a large, “cherry red” epiglottis Rx. A-Patient should be managed in the ICU with continuous oxygen, IV fluids & frequent monitoring. B-ET intubation or tracheostomy should be considered in all patients with epiglottitis for 2-3 day C-Antibiotics given parenterally for 10 days e.g. Ceftriaxone, Cefotaxime, or Ampicillin - Sulbactam.

BARKING COUPH 🔑 STRIDOR 🔑

STEEPLE 🔑

Acute upper airway obstruction 1 - Croup STEEPLE 🔑, BARKING 🔑, STRIDOR 🔑 شنو هي بالبداية ؟ Acute viral inflammation of upper airway causing oedema of larynx and trachea and presenting with BARKING cough🔑, STRIDOR 🔑 and respiratory distress Causative agent: parainfluenza virus (sometimes influenza, respiratory syncytial virus, rhinovirus) زين شوكت افكر بيها ؟ Age group : 6 month to 3 years Specially at 2 years old of age C/P Preceding coryzal illness راح تسمع من الاهل هستري مال انفلونزا خلال الايام القليلة الراحت Fever Harsh BARK/seal-like cough 🔑 Hoarse voice Inspiratory STRIDOR 🔑 Symptoms worse at night Child does not look toxic مهمة كلشش للتفريق عن باقي اسباب ال Stridor انو ما يكون الطفل كلش toxic Diagnosis : according to the clinical presentation CXR العلامة النمطية لل كروب Steeple sign 🔑 severity signs 🆘 CROUP C : cyanosis R : Recession of chest O : Oxygen saturations >92% UP: Upper airway obstruction (stridor at rest ) rarely cause complete obstruction ❗️❗️ RX Airway management الاولوييية القصوى Humidified O2 Paracetamol or Ibuprofen Dexamethasone علمود نقلل الاديما Nebulised adrenaline NEVER FORGET THE GOLDEN KEYS

Section 1 : PediaAriways “Every breath of a child— Will be decoded, clarified, and deeply understood.” 1-Croup 2-Epiglottits 3-Forgein Body 4-Retropharyngeal Abscess

Content : Section 1 : PediaAriways