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Why ?
Answers:
一、Anatomy
(一)Upper respiratory tract (cricoid cartilage)
1) Nose
No hairs of vestibule of nose, narrowed nasal cavity,
rich blood vessels in mucosa
Auditory tube is short, wide and horizontal
tympanitis
2) Pharynx
Pharyngeal tonsil develops well at 4—10 years
old, after 13—15years old it atrophy
3) Throat
narrowed cavity, rich blood vessels in mucosa
asphyxia
(二)Lower respiratory tract
1) Trachea and bronchia
narrowed tube, rich blood vessels in mucosa, the movement of
cilia is weak
2) Lung
20 million alveoli at birth, 200 million by 3 years of age,
200—600 million in adult
rich capillaries and pulmonary interstitium
〔 Etiology〕
Rhinovirus Streptococcus
Respiratory syncytial virus Staphylococcus
Influenza virus S.pneumoniae aureus
Parainfluenza virus Haemophilus Influenzae
Coronavirus
Adenovirus
Enterovirus
〔 Clinical manifestations 〕
Pharyngo-conjunctival fever
adenovirus 3,7 type
fever+ laryngitis+conjunctivitis
〔 Complications〕
otitis media, sinusitis, enlarged lymph nodes
1) Nonpharmacologic therapy:
elevating head(older children), parents ceasing
smoking,
frequent intake of fluid.
2) When children with URI are uncomfortable, the
most bothersome symptoms are fever and malaise,
nasal discharge or nasal congestion,therapy should
be directed toward a specific symptom that
causing discomfort. Acetaminophen or ibuprofen
is often helpful in relieving the constitutional
symptoms and the fever.
heart rate
increasing agitation
drowsiness, tiredness,exhaustion
central cyanosis indicating severity hypoxaemia and
the need for urgent intervention
〔 Treatment〕
1 、Airway management
2 、Antibiotics
3 、Corticosteroid
4 、Phergan
5 、Tracheotomy
Acute bronchitis
〔 Etiology 〕
Bacteria and virus
Acute tracheobronchitis is commonly
associated with an upper respiratory tract
infection.
Some children appear to be far more susceptible to
acute tracheobronchitis than others. The reasons are
unknown, but allergy, climate, air pollution, and
chronic infection of the upper respiratory tract,
particularly sinusitis, maybe contributing factors.
〔 Clinical manifestations 〕
1 、Systematic
2 、Local: cough, sputum,
roughening of breath sounds
dry and/or moist rales,
changeable
3 、Asthmatic bronchitis
1) Atopic (eczema, allergic rhinitis)
2) Wheezing, rhonchi to be sharp in expiration,
prolonging expiration
3) Recurrent episodes
4) <3 years old
There is also disagreement over the use of this term,
many authorities define this as a presentation of
asthma, while others consider that the bronchial
inflammation and smooth muscle spasm are related
to the effect of the particular infectious organisms
affecting infants rather than to the child’s permanent
predisposition to bronchial hyperreactivity.
〔 Treatment 〕
1 、nonspecific therapy
2 、Antibiotics
3 、pulmonary drainage by frequent shifts in position,
cough suppressants (codeine),
drain sputum (ammonium chloride, acetylcyteine)
relieve wheezing (Bricany. amminophyllin)
Bronchiolitis
Parainfluenza virus ,
adenovirus,
mycoplasmal pneumoniae
(HMPV)
〔Pathology〕
3 、Antivirus therapy
Ribavirin is given by a
1 、Humidified oxygen
nebulizer for 12-18 hours of
2 、intravenous hydration every day for 3-5 days
But there is controversy
5 、 nebulized budesonide:
6、Humanized- RSV monoclonal antibody is now commended
to prevent severe disease in high-risk patient in epidemic
period.
Monthly intramuscular administration.
7、Treatment of complication
Acidosis,respiratory failure et al.
〔Prognosis〕
50% of hospitalized patients will wheeze later in
childhood, asthma.
Pneumonia
〔Definition〕
Pneumonia is an inflammation of the parenchyma of the
lung.
Most of the cases of pneumonia are caused by
microorganisms, but a number of noninfectious causes
sometimes need to be considered, aspiration of food or
gastric acid, foreign bodies, hydrocarbons and lipid
substances, and drug-or radiation induced pneumonitis .
〔Classification〕
1) Pneumonia has been classified on an anatomic basis as a
lobar or lobular, alveolar, or interstitial process
2) but classification of infectious pneumonia on the basis of
presumed or proven etiology is diagnostically more relevant.
〔 Etiology 〕
Respiratory syncytial virus s.pneumoniae
Adenovirus Streptococcus
Influenza virus Staphylococcus aureus
Parainfluenza virus Haemophilus Influenza
Enterovirus
Mycoplasma
Chlamydia
organisms(virus、bacteria) toxin
bronchitis
pneumonia
hypercapnia hypoxemia
of the subclavicular
intercostal, and subcostal
areas,tachypnea and
tachycardia)
4 、cyanosis (peripheral and central)
5 、signs in lung:
( 1 )Cardiology
after giving oxygen ,sedatives
3 ) RR>60 /min
5 )oliguria or anuria,edema
( 2 )Neurology:lethargy,coma,convulsion,bulging fontanelle,
( 3 )Gastroenterology:gastrointestinal bleeding, abdomen distension
〔 Complications〕:empyema, abscesses
pyopneumothorax
pneumatocele.
〔 Chest X-ay 〕:
patchy infiltrates,
atelectasis,
(frontal and lateral
views)
〔 Laboratory findings〕
1. Bronchitis
2. TB
1 、Staphylococcus aureus pneumonia
①Patient’s condition changes abruptly,with the onset of
high fever, a rapid progression of symptoms
X –ray: infiltrates
〔 Treatment〕
Antimicrobial therapy
① Principle:depend on the organism isolated from the
patient,drug sensitive test, or clinical manifestations.
helmet,flux 3-5liter/min
airway management:drain sputum,bronchodilator,
shift position