Dd wheezy chest in infant for fm

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for Family Medicine, G pediatrician, medical student

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  • Shaded text wrapped around a corner(Basic)To reproduce the effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank.On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box.Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Haettenschweiler from the Font list, and then select 24 from the Font Size list.On the Home tab, in the Paragraph group, click Center to center the text on the slide.Select the text box. Under Drawing Tools, on the Format tab, in the WordArt Styles group, click Text Effects, point to Transform, and then under Warp click Triangle Up (first row, third option from the left). Drag the pink diamond adjustment handle (at the left side of the text box) to adjust the amount of text warp. Select the text. Under Drawing Tools, on the Format tab, in the WordArt Styles group, click the arrow next to Text Fill, point to Gradient, and click More Gradients. In the Format Text Effects dialog box, click Text Fill in the left pane, select Gradient fill in the Text Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then click Linear Right (first row, fourth option from the left).In the Angle box, enter 0°.Under Gradient stops, click Add or Remove until five stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%. Click the button next to Color, and then under Theme Colors click Blue, Accent 1, Lighter 60% (third row, fifth option from the left).Select Stop 2 from the list, and then do the following:In the Stop position box, enter 17%. Click the button next to Color, and then under Theme Colors click Blue, Accent 1, Lighter 80% (second row, fifth option from the left).Select Stop 3 from the list, and then do the following:In the Stop position box, enter 50%. Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 4 from the list, and then do the following:In the Stop position box, enter 51%. Click the button next to Color, and then under Theme Colors click Blue, Accent 1, Lighter 40% (fourth row, fifth option from the left).Select Stop 5 from the list, and then do the following:In the Stop position box, enter 100%. Click the button next to Color, and then under Theme Colors click Blue, Accent 1, Darker 25% (fifth row, fifth option from the left).Under Drawing Tools, on the Format tab, in the WordArt Styles group, click Text Effects, point to Reflection, and then under Reflection Variations click Tight Reflection, touching (first row, first option from the left).To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then click Linear Down (first row, second option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 64%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left).Select Stop 2 from the list, and then do the following:In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Blue, Accent 1, Darker 25% (fifth row, fifth option from the left).
  • Donut with text inside(Intermediate)To reproduce the donut shape on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank.On the Home tab, in the Drawing group, click Shapes, and then under Basic Shapes click Donut (third row, second option from the left). On the slide, drag to draw a donut. Drag the yellow diamond adjustment handle to the left to decrease the width of the donut. Select the donut. Under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 5.92”.In the Shape Width box, enter 5.92”.Under Drawing Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Outline, and then click No Outline. Also under Drawing Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Fill, and then under Theme Colors click Olive Green, Accent 3, Darker 25% (fifth row, seventh option from the left). Also under Drawing Tools, on the Format tab, in the Shape Styles group, click Shape Effects, and then do the following:Point to Bevel, and then under Bevel click Soft Round (second row, second option from the left). Point to Shadow, and then under Outer click Offset Diagonal Bottom Right (first row, first option from the left).To reproduce the text on this slide, do the following:On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box.Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Consolas from the Font list, enter 27 in the Font Size box, click the button next to Font Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). Tip: To enter the two bullets with the text, on the Insert tab, in the Text group, click Symbol. In the Symbol dialog box, do the following:In the Font list, select (normal text).In the Character Code box, enter 0095 to select BULLET, and then click Insert.On the Home tab, in the Paragraph group, click Align Text Left to align the text left in the text box. Select the text box. Under Drawing Tools, on the Format tab, in the WordArt Styles group, click Text Effects, and then do the following:Point to Shadow, and then under Outer click Offset Diagonal Bottom Right (first row, first option from the left). Point to Transform, and then under Follow Path click Circle (third option from the left). Under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 4.78”.In the Shape Width box, enter 4.78”.Drag the text box onto the donut shape so that the text wraps around the donut. If the text does not wrap completely and evenly around the donut shape, select the text box and then do the following:If the text does not wrap completely around the donut shape, on the Home tab, in the Font group, in the FontSize box, enter larger font sizes in 1-pt increments until the text is evenly spaced within the donut shape. If the entire line of text does not fit evenly within the donut shape, on the Home tab, in the Font group, in the FontSize box, enter smaller font sizes in 1-pt increments until the text is evenly spaced within the donut shape.If the text does not wrap completely around or does not fit evenly within the donut shape, also try editing the CharacterSpacing. On the Home tab, in the Font group, click CharacterSpacing, and then do the following:To expand the text, in the CharacterSpacing list, select Loose or VeryLoose. To contract the text, in the CharacterSpacing list, select Tight or VeryTight.For more precise character spacing, click More Spacing. In the Font dialog box, on the Character Spacing tab, in the Spacing list, select Expanded or Condensed. In the By box, adjust the size by 0.1-pt increments until the text is spaced evenly.Press and hold SHIFT, and then select the text box and the donut shape. On the Home tab, in the Drawing group, click Arrange, and then click Group. Select the group. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Center.Click Align Middle. To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until three stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click Aqua, Accent 5, Darker 25% (fifth row, ninth option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 54%.Click the button next to Color, and then under Theme Colors click Aqua, Accent 5, Darker 50% (sixth row, ninth option from the left). Select Stop 3 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left).
  • Stacked, 3-D text with center perspective(Intermediate)To reproduce the text effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank.On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box.Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Impact from the Font list, and then change the font size of each line so that the text is approximately the same width. For example, if you entered FIRST on the first line, SECOND on the second line, and THIRD on the third line (as shown on the slide), do the following:Select the first line of text, and then on the Home tab, in the Font group, enter 92 in the Font Size box. Select the second line of text, and then on the Home tab, in the Font group, enter 65 in the Font Size box. Select the third line of text, and then on the Home tab, in the Font group, enter 92 in the Font Size box. Select all of the text. On the Home tab, in the Font group, click Character Spacing, and then click More Spacing. In the Font dialog box, on the Character Spacing tab, in the Spacing list, select Expanded. In the By box, enter 2.On the Home tab, in the Paragraph group, click Center to center the text in the text box.Under Drawing Tools, on the Format tab, in the bottom right corner of the WordArt Styles group, click the Format Text Effects dialog box launcher. In the Format Text Effects dialog box, click Text Fill in the left pane. Select Solid fill in the Text Fill pane, click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 15% (fifth row, second option from the left). Also in the Format Text Effects dialog box, click 3-D Rotation in the left pane, click the button next to Presets in the 3-D Rotation pane, and then under Perspective click Perspective Front (first row, first option from the left). Also in the Format Text Effects dialog box, click 3-D Format in the left pane, and then do the following in the 3-D Format pane:Under Depth, click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). In the Depth box, enter 300 pt. Under Surface, click the button next to Material, and then under Standard click Matte (first row, first option from the left). Click the button next to Lighting, and then under Neutral click Balance (first row, second option from the left). To reproduce the lines behind the text, do the following:On the Home tab, in the Drawing group, click Shapes, and then under Rectangles, click Rectangle (first option from the left). On the slide, drag to draw a rectangle.On the Home tab, in the Drawing group, click the arrow next to Shape Fill, and then click No Fill.On the Home tab, in the Drawing group, click the arrow next to Shape Outline, and then under Theme Colors click White, Background 1 (first row, first option from the left). On the Home tab, in the Drawing group, click the arrow next to Shape Outline, point to Weight, and then click More Lines.In the Format Shape dialog box, click Line Style in the left pane. In the Line Style pane, in the Width box, enter 2 pt.On the Home tab, in the Drawing group, click Arrange, and then click Send to Back.To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 10%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following:In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left).
  • Stacked, 3-D text with center perspective(Intermediate)To reproduce the text effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank.On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box.Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Impact from the Font list, and then change the font size of each line so that the text is approximately the same width. For example, if you entered FIRST on the first line, SECOND on the second line, and THIRD on the third line (as shown on the slide), do the following:Select the first line of text, and then on the Home tab, in the Font group, enter 92 in the Font Size box. Select the second line of text, and then on the Home tab, in the Font group, enter 65 in the Font Size box. Select the third line of text, and then on the Home tab, in the Font group, enter 92 in the Font Size box. Select all of the text. On the Home tab, in the Font group, click Character Spacing, and then click More Spacing. In the Font dialog box, on the Character Spacing tab, in the Spacing list, select Expanded. In the By box, enter 2.On the Home tab, in the Paragraph group, click Center to center the text in the text box.Under Drawing Tools, on the Format tab, in the bottom right corner of the WordArt Styles group, click the Format Text Effects dialog box launcher. In the Format Text Effects dialog box, click Text Fill in the left pane. Select Solid fill in the Text Fill pane, click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 15% (fifth row, second option from the left). Also in the Format Text Effects dialog box, click 3-D Rotation in the left pane, click the button next to Presets in the 3-D Rotation pane, and then under Perspective click Perspective Front (first row, first option from the left). Also in the Format Text Effects dialog box, click 3-D Format in the left pane, and then do the following in the 3-D Format pane:Under Depth, click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). In the Depth box, enter 300 pt. Under Surface, click the button next to Material, and then under Standard click Matte (first row, first option from the left). Click the button next to Lighting, and then under Neutral click Balance (first row, second option from the left). To reproduce the lines behind the text, do the following:On the Home tab, in the Drawing group, click Shapes, and then under Rectangles, click Rectangle (first option from the left). On the slide, drag to draw a rectangle.On the Home tab, in the Drawing group, click the arrow next to Shape Fill, and then click No Fill.On the Home tab, in the Drawing group, click the arrow next to Shape Outline, and then under Theme Colors click White, Background 1 (first row, first option from the left). On the Home tab, in the Drawing group, click the arrow next to Shape Outline, point to Weight, and then click More Lines.In the Format Shape dialog box, click Line Style in the left pane. In the Line Style pane, in the Width box, enter 2 pt.On the Home tab, in the Drawing group, click Arrange, and then click Send to Back.To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 10%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following:In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left).
  • Stacked, 3-D text with center perspective(Intermediate)To reproduce the text effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank.On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box.Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Impact from the Font list, and then change the font size of each line so that the text is approximately the same width. For example, if you entered FIRST on the first line, SECOND on the second line, and THIRD on the third line (as shown on the slide), do the following:Select the first line of text, and then on the Home tab, in the Font group, enter 92 in the Font Size box. Select the second line of text, and then on the Home tab, in the Font group, enter 65 in the Font Size box. Select the third line of text, and then on the Home tab, in the Font group, enter 92 in the Font Size box. Select all of the text. On the Home tab, in the Font group, click Character Spacing, and then click More Spacing. In the Font dialog box, on the Character Spacing tab, in the Spacing list, select Expanded. In the By box, enter 2.On the Home tab, in the Paragraph group, click Center to center the text in the text box.Under Drawing Tools, on the Format tab, in the bottom right corner of the WordArt Styles group, click the Format Text Effects dialog box launcher. In the Format Text Effects dialog box, click Text Fill in the left pane. Select Solid fill in the Text Fill pane, click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 15% (fifth row, second option from the left). Also in the Format Text Effects dialog box, click 3-D Rotation in the left pane, click the button next to Presets in the 3-D Rotation pane, and then under Perspective click Perspective Front (first row, first option from the left). Also in the Format Text Effects dialog box, click 3-D Format in the left pane, and then do the following in the 3-D Format pane:Under Depth, click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). In the Depth box, enter 300 pt. Under Surface, click the button next to Material, and then under Standard click Matte (first row, first option from the left). Click the button next to Lighting, and then under Neutral click Balance (first row, second option from the left). To reproduce the lines behind the text, do the following:On the Home tab, in the Drawing group, click Shapes, and then under Rectangles, click Rectangle (first option from the left). On the slide, drag to draw a rectangle.On the Home tab, in the Drawing group, click the arrow next to Shape Fill, and then click No Fill.On the Home tab, in the Drawing group, click the arrow next to Shape Outline, and then under Theme Colors click White, Background 1 (first row, first option from the left). On the Home tab, in the Drawing group, click the arrow next to Shape Outline, point to Weight, and then click More Lines.In the Format Shape dialog box, click Line Style in the left pane. In the Line Style pane, in the Width box, enter 2 pt.On the Home tab, in the Drawing group, click Arrange, and then click Send to Back.To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 10%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following:In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left).
  • Stacked, 3-D text with center perspective(Intermediate)To reproduce the text effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank.On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box.Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Impact from the Font list, and then change the font size of each line so that the text is approximately the same width. For example, if you entered FIRST on the first line, SECOND on the second line, and THIRD on the third line (as shown on the slide), do the following:Select the first line of text, and then on the Home tab, in the Font group, enter 92 in the Font Size box. Select the second line of text, and then on the Home tab, in the Font group, enter 65 in the Font Size box. Select the third line of text, and then on the Home tab, in the Font group, enter 92 in the Font Size box. Select all of the text. On the Home tab, in the Font group, click Character Spacing, and then click More Spacing. In the Font dialog box, on the Character Spacing tab, in the Spacing list, select Expanded. In the By box, enter 2.On the Home tab, in the Paragraph group, click Center to center the text in the text box.Under Drawing Tools, on the Format tab, in the bottom right corner of the WordArt Styles group, click the Format Text Effects dialog box launcher. In the Format Text Effects dialog box, click Text Fill in the left pane. Select Solid fill in the Text Fill pane, click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 15% (fifth row, second option from the left). Also in the Format Text Effects dialog box, click 3-D Rotation in the left pane, click the button next to Presets in the 3-D Rotation pane, and then under Perspective click Perspective Front (first row, first option from the left). Also in the Format Text Effects dialog box, click 3-D Format in the left pane, and then do the following in the 3-D Format pane:Under Depth, click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). In the Depth box, enter 300 pt. Under Surface, click the button next to Material, and then under Standard click Matte (first row, first option from the left). Click the button next to Lighting, and then under Neutral click Balance (first row, second option from the left). To reproduce the lines behind the text, do the following:On the Home tab, in the Drawing group, click Shapes, and then under Rectangles, click Rectangle (first option from the left). On the slide, drag to draw a rectangle.On the Home tab, in the Drawing group, click the arrow next to Shape Fill, and then click No Fill.On the Home tab, in the Drawing group, click the arrow next to Shape Outline, and then under Theme Colors click White, Background 1 (first row, first option from the left). On the Home tab, in the Drawing group, click the arrow next to Shape Outline, point to Weight, and then click More Lines.In the Format Shape dialog box, click Line Style in the left pane. In the Line Style pane, in the Width box, enter 2 pt.On the Home tab, in the Drawing group, click Arrange, and then click Send to Back.To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 10%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following:In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left).
  • Expanded text with bevel and shadow(Basic)To reproduce the text effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank.On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box.Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Calisto MT from the Font list and then select 60 from the Font Size list.On the Home tab, in the Paragraph group, click Center to center the text in the text box.On the Home tab, in the Font group, click Character Spacing, and then click More Spacing. In the Font dialog box, on the Character Spacing tab, in the Spacing list, select Expanded. In the By box, enter 22.Under Drawing Tools, on the Format tab, in the WordArt Styles group, click the arrow next to Text Fill, and then under Theme Colors click Tan, Background 2, Darker 50% (fourth row, third option from the left). Under Drawing Tools, on the Format tab, in the bottom right corner of the WordArt Styles group, click the Format Text Effects dialog box launcher. In the Format Text Effects dialog box, click 3-D Format in the left pane, and then do the following in the 3-D Format pane:Under Bevel, click the button next to Top, and then under Bevel click Soft Round (second row, second option from the left). Next to Top, in the Width box, enter 4 pt, and in the Height box,enter 6 pt. Under Depth, click the button next to Color, and then under Theme Colors click Tan, Background 2, Darker 50% (fourth row, third option from the left). In the Depth box, enter 6 pt. Under Contour, click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). In the Size box, enter 0 pt. Under Surface, click the button next to Material, and then under Translucent click Powder. Click the button next to Lighting, and then under Warm click Morning. Also in the Format Text Effects dialog box, click Shadow in the left pane, and then do the following in the Shadow pane:Click the button next to Presets, and under Perspective, click Perspective Diagonal Upper Left (first row, first option from the left). In the Transparency box, enter 85%. To reproduce the background on this slide, do the following:Right-click the slide background area, then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Corner (first option from the left).Under Gradient stops, click Add or Remove until three stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 45%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following:In the Stop position box, enter 80%.Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 223, Green: 219, Blue: 211.Select Stop 3 from the list, and then do the following:In the Stop position box, enter 100%.Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 213, Green: 208, Blue: 197.
  • Dd wheezy chest in infant for fm

    1. 1. Definition• A wheeze is a high-pitched, musical, adventitious lung sound produced by airflow through an abnormally partially narrowed or compressed lower airway• A wheeze is synonymous with a high-pitched or sibilant rhonchus.
    2. 2. • Wheezes are heard more commonly during expiration• Wheezing during expiration alone = milder obstruction• Wheezing during both inspiration and expiration = more severe airway narrowing.• Wheezing may be acute or chronic /recurrent
    3. 3. Acute bronchiolitis Foreign Cardiac body asthma aspiration Differential DiagnosisPneumonia GERD Vascular Bronchial ring asthma
    4. 4. Clinical syndromeCharacterized by pulmonaryhyperinflation and wheezingDue toacute, infectious, inflammatoryobstruction of small airways(bronchioles)** With no muscle layer
    5. 5. Parainfluenza, Adenovirus, Influenza,75% Mycoplasma etc Respiratory Syncytial Virus
    6. 6. Accumulation of mucus, Edema, Cellular debris Complete bronchiolar AtelectasisViral invasion of obstructionsmall bronchi & bronchioles Incomplete Early air trapping obstruction (Ball during expiration valve) Over inflation of lung
    7. 7. Sex Age Food Season• Male is • First 2 • Non- • Winter 1.25 years of breastfed and early times life spring more • Peak at 2- frequently 8 months than female
    8. 8. SYMPTOMS OF PNEUMONIAFever, toxic ill, cough, dyspnea and grunting SIGNS OF ASTHMA retraction Hyperinflation, decrease TVF Diminish airway, Harsh V breathing, Decrease VR, Wheeze
    9. 9. Mild Upper Respiratory Tract Infection for 2-3 daysGradual onset of Respiratory Distress Paroxysmal Spasmodic Cough Wheezes Dyspnea Irritability +- Feeding difficulty due to tachypnea
    10. 10. SIGN
    11. 11. Respiration fast & Decrease air entryshallow. Hyper Harsh vesicularLabored breathing resonant breathing +(chest note due to prolongedindrawing, flaring expirationalae nasi, IC over Inspiratory +retraction) inflated expiratory wheezesAir hungerRestlessness lungs Inspiratory widespread fineCyanosis crackles
    12. 12. Differences between bronchiolitis and bronchial asthma• 1-Asthma is not common in the first year.• 2-The following may favors the diagnosis of asthma which are: -positive family history, repeated attacks, markedly prolonged expiration, onset may be sudden, without preceeding URT infection., there will be eosinophilia and favourable response to bronchodilators.
    13. 13. Course of the disease• -A critical phase in first 48-72 hours by which the patient is desperately ill and apneic spells occur in the very young infants and the followed by rapid improvement.• - In the outcome of the long term, some children may develop persistent airway hyperactivity later in childhood.
    14. 14. Complications:• 1-Bacterial superinfections e.g- bronchopneumonia.• 2-Cardiac failure: rare, mainly in patients with underlying cardiopulmonary disease example congenital heart disease, cystic fibrosis, bronchopulmonary dysplasia.• 3-Death due to severe course with prolonged apneic spells, severe uncompensated respiratory acidosis and profound dehydration due to tachypnea and inability to drink due to respiratory distress.•
    15. 15. Investigations• Laboratory studies• Imaging studies• Other tests
    16. 16. Laboratory studies. X ray ( or CT chest)• A CBC is seldom useful since the white blood cell count is usually within normal limits.• Arterial blood gases (ABG).
    17. 17. Imaging studies• These are not routinely necessary.• Hyperinflation and patchy infiltrates may be seen; but these are non - specific• Focal atelectasis• Air trapping• Flattened diaphragm• Increased anteroposterior diameter• Peribronchial cuffing• Chest radiographs may also reveal evidence of alternative diagnoses, such as lobar pneumonia, congestive heart failure, or foreign body aspiration.
    18. 18. • A chest X-ray demonstrating lung hyperinflation with a flattened diaphragm and bilateral atelectasis in the right apical and left basal regions in a 16-day-old infant with severe bronchiolitis
    19. 19. Other tests• Antigen tests of nasal washings provide rapid and accurate detection of RSV.• A positive culture or direct fluorescent antibody test result can confirm the diagnosis of RSV infection.• Cultures of RSV are considerably less sensitive (60%) but are 100% specific.
    20. 20. Treatment and medications• General supportive measures are the mainstay of treatment for patients with bronchiolitis. Oxygen Fluids Nutrition
    21. 21. • Avoid sedatives!
    22. 22. Medications• Antiviral drugs – only to those have severe RSV infections or high risk infants (Ribavirin)• Antibiotics – Of no values• Corticosteroids – their use is controversial• Nebulized B2 – agonists – their use are also controversial• Aerosolized racemic epinephrine – may have some benefits as they have a vasoconstrictor effect
    23. 23. Prevention:• Exclusive breastfeeding for the first 6 months decrease the risk of acquiring the RSV infection.• -Avoid exposure to viral URTI during respiratory illness season.• -Passive immune-prophylaxis with intravenous anti-RSV immune globulin or intramuscular anti RSV monoclonal antibodies, this is given to selected small infants with underlying cardio- pulmonary disorders.• -Vaccination is not yet available and preventive vaccines are currently being studied.
    24. 24. FOREIGN BODY
    25. 25. Foreign body aspiration• very serious, often life-threatening condition• Ninety percent of deaths occur in patients who are younger than 5 years, and two thirds of these deaths occur in infants.
    26. 26. Why? exploration learning to inadequate immature of their walk and run dentition swallowingenvironment coordination by putting objects intotheir mouths
    27. 27. What?
    28. 28. Pathophysiology Complete airway Partial airway obstruction obstruction partially occluded or if airway at levels above the obstruction occurs the carina distal to the carinaacute onset of respiratory recurrent pneumonia, distress in which the persistent cough,patient is unable to speak hemoptysis, wheezing, or cough or atelectasis
    29. 29. Diagnosis• History – Positive history can be obtained – but often complicated by the fact that the event may be unwitnessed in 90% of the case, witnessed by a person not present for history taking, or witnessed by an older sibling who may have had a role in the aspiration and chooses not to say anything.
    30. 30. Clinical picture First phase Second phase Third phase• immediately following the • asymptomatic period • renewed symptomatic incident • can last from minutes to period• choking, gagging, coughing, months following the • Airway inflammation or wheezing, and/or stridor incident infection occurs• associated temporary • of cough, wheezing (maybe cyanotic episode unilateral) , fever, sputum production, and occasionally, hemoptysis.
    31. 31. • Imaging – most foreign bodies are not radiopaque – findings suggestive of the presence of a foreign body such as hyperinflation mediastinal shift atelectasis• Other test: – Bronchoscopy : diagnostic and therapeutic
    32. 32. Expiratory chest radiograph in a 12-month-old boy with a 2-monthhistory of wheezing demonstrates continued hyperlucency andhyperexpansion of the right hemithorax. A greater mediastinal shift isnoted toward the left lung field. A corn kernel was removed from thepatients right mainstem bronchus during bronchoscopy
    33. 33. Treatment• No response to bronchodilators• Bronchoscopy
    34. 34. GERD in infant• Most of the time, reflux in infants is due to a poorly coordinated gastrointestinal tract.• Many infants with the condition are otherwise healthy; however, some infants can have problems affecting their nerves, brain or muscles.• Certain factors also may contribute to GERD, including: obesity, overeating, certain foods, some beverages, and specific medications.• There also appears to be an inherited component to GERD, as it is more common in some families than in others
    35. 35. GERD and wheezes? GERD Aspiration
    36. 36. Signs and symptoms• Frequent or recurrent vomiting• Frequent or persistent cough• Heartburn, gas, abdominal pain, or colicky behavior (frequent crying and fussiness)• Regurgitation and re-swallowing• Colic (frequent crying and fussiness)• Feeding problems wet burp or frequent hiccups
    37. 37. • Recurrent choking or gagging• poor sleep habits typically with frequent waking• arching their necks and back during or after eating• frequent ear infections or sinus congestion• Poor growth• Breathing problems• Recurrent wheezing
    38. 38. Investigations• Ultrasound• Barium swallow• Esophageal pH monitoring• Scintigraphy (isotope scan)• Endoscopy
    39. 39. Ultrasound
    40. 40. Barium swallow
    41. 41. Esophageal pH monitoring
    42. 42. Scintigraphy• Caloric liquid or solid meal appropriate to the patient’s age were used: 200 to 250 mL of formula or breast milk for small infants was labeled with isotope• After the ingestion of the radiolabeled test meal at lunchtime, the patient was given a small portion of the unlabeled meal to wash out all previously ingested radioactivity from the esophagus• Images then taken with the gamma camera.
    43. 43. Endoscopy

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