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Respiratory approach

Respiratory approach. Approach to chronic cough. Definition Hints in history a- nature of cough b- diurnal variation c- associated symptoms d. exacerbating factors and relieving factors e- associated symptoms f- family history. Cough in asthma A- usually dry B- more at night

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Respiratory approach

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  1. Respiratory approach

  2. Approach to chronic cough • Definition • Hints in history a- nature of cough b- diurnal variation c- associated symptoms d. exacerbating factors and relieving factors e- associated symptoms f- family history

  3. Cough in asthma A- usually dry B- more at night C- respond to bronchodilators D- associated with wheeze E- symptom- free periods

  4. Examination: Signs indicating chronic serious lower respiratory tract disease: A- failure to thrive B- clubbing of fingers C- chest deformity

  5. Other signs to look for A- signs of allergy B- nasal polyps C- signs of immunodeficiency E- lymph nodes F- cardiac murmurs E-organomegaly F- skin rashes

  6. Investigation A- CBC B- LFT E- CXR, Sinus and previous Xrays F- Sweat chloride test E- Immune screen F- PH monitoring G- PFT and bronchoscopy

  7. 6 months old with chronic cough, sweat chloride 70, 75 in 2 occasions, lymphocytes counts 400, 450 in 2 occasions: What results u believe in? What's the diagnosis?

  8. 2 years old with recurrent admissions due to patchy pneumonias, manifested by cough, wheeze. Good response to nebulizer, negative blood cultures. A- is it recurrent bacterial pneumonia B- indication for further investigation C- is it bronchial asthma

  9. Bronchial asthma suspect in all the followings: A- chronic cough, chronic bronchitis B- recurrent pneumonias without bacteriological proof C- unequivocal response to ventolin nebulizer

  10. Bronchial asthma: A- definition: B- other diagnosis mimicking asthma C- most important history: • Diurnal variation and seasonal • Exacerbating factors • Relieving factors • Associated other atopic features

  11. symptom-free periods • Parental history of asthma • Environmental

  12. Attack of asthma Interventional medication: • Systemic steroids • Ventolin administration +/- anticholinergic • Mg sulphate • Adrenaline

  13. Asthma attack Indication for admission: • Dehydration • O2 sat <92 after treatment • Apnea • Convulsion • Previous Icu admission • Respiratory distress interfering with eating and activity

  14. Asthma attack: Discharge: • Able to have oral intake • No use of accessory muscle • O2 sat>92 • Discharge on steroid for 3-5 days and Ventolin inhaler and controllers

  15. Asthma:controllers: • Steroid inhalers: availables: Beclomathasone(clenil) Budesonide( pulmicort) Fluticasone(flexetide) Combination: Symbicort, Seretide, Theophylline, Antileucotreines

  16. What to follow: • Growth parameter • Cataract • Asthma control: sleep and activity disturbances, use of ventolin, acute care visits

  17. Recurrent pneumonia • Definition • Most popular causes in children: • Cystic fibrosis • PCD • Immunedeficiency • Recurrent aspiration( CP patients)

  18. pneumonias • Indications to look for underlying cause: • Severe • Persistent • Unusual organisms • Recurrent

  19. Cystic fibrosis • Definition • Systems involved: • respiratory, killing • GI • Reproductive system

  20. CF • Other manifestations: • Hypotonic, hypoelectrolytemic dehydration with alkalosis( infants, recurrent) • Syndrome of Anemia, edema and Anemia • Neonatal cholestasis

  21. CF • Diagnosis: • Sweat chloride • Gene mutation • Nasal potential difference

  22. CF • Treatment: • respiratory: Antibiotics the cornerstone of treating CF • GI: enzyme replacement, vitamins, diet • Liver disease • complications

  23. Airmay obsrtruction • Cardinal sign: Stridor • Classification • Acute( toxic and notoxic) and chronic • Congenital or aquired

  24. Clinical manifestation • Stridor : ( Inspiratory stridor ) - Harsh sound produced by vibration of upper airway structure - Indicates upper airway obstruction • Hoarseness: Indicates involvement of vocal cords • Respiratory distress / suprasternal retraction

  25. stridors • Toxic : - Acute epiglotitis - Bacterial tracheitis -Retropharyngeal abcess and retrotonsillar abcess(quinze) Nontoxic: Croup Foreign body

  26. CROUP (also termed laryngotracheitis or laryngotracheobronchitis): Is a respiratory condition, that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside larynx and trachea but may also extend to the bronchi produces the classical symptoms of a "barking" cough, stridor, and hoarseness.

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