Pediatrics(2)
.pdf-Possibility of septicaemia.
-Acute clinical deterioration.
-High white cell count.
-Progressive infiltrative changes on chest radiograph.
-Give oral or parenteral antibiotics for 5 days based on severity and/or condition of the patient as follow:
• Amoxicillin 25mg per dose/kg/day Q12hr PO Or
• Ampicillin injections IM: 100 mg/kg/day in 3 divided doses or
-Alternative treatment:
• Erythromycin 30 -50 mg per dose/kg/day x3/day/7-10days
Note: Evidence on Treatment of bronchospasms does not support routine use of bronchodilators, steroids or antibiotics.
If bronchodilators are to be used, closely monitor effect as it might worsen respiratory distress
1.3.2. Asthma
Definition: Asthma is a chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction.
Causes
- Unknown but the following factors have been identified:
•Allergens (e.g., house dust, perfumes, food, animal airs, mites)
•Medicine (e.g., propranolol and aspirin)
•Environmental (e.g., change of weather, polluants), Infections (viral or bacterial)
•Emotions
•Family history (genetic factors)
• Gastro-esophageal reflux Signs and Symptoms
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Breathlessness
-Wheezing/ prolonged expiratory
-Cough (chronic nocturnal cough)
-Exercise induced cough
-Chest tightness
-Sputum production
Signs and Symptoms
Note: Asthma can often be diagnosed on the basis of a patient’s symptoms and medical history.
Presence of any of these signs and symptoms should increase the suspicion of asthma:
-Wheezing high-pitched whistling sounds when breathing out-especially in children.
-History of any of the following:
•Cough, worse particularly at night
•Recurrent wheeze
•Recurrent difficult breathing
•Recurrent chest tightness
•Symptoms occur or worsen at night, awakening the patient
•Symptoms occur or worsen in a seasonal pattern
•The patient also has eczema, hay fever, or a family history of asthma or atopic diseases
- Symptoms occur or worsen in the presence of:
•Animals with fur
•Aerosol chemicals
•Changes in temperature
•domestic dust mites
•drugs (aspirin, beta blockers)
•Exercise
•Pollen
•Respiratory (viral) infections
•Smoke
•Strong emotional expression
-Symptoms respond to anti-asthma therapy
-Patients colds “go to the chest” or take more than 10 days to clear up
Complications
-Uncontrolled/poorly controlled asthma can lead to severe lung damage
-Severe asthma exacerbation can cause respiratory failure and death
Investigations
-Lung function to confirm diagnosis and assess severity
-Peak expiratory flow rate can help diagnosis and follow up
-Additional diagnostic tests
•Allergy testing (where applicable)
•Chest X-ray (for differential diagnosis)
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FBC for exclusion of super-infection Management