MBBS lecture

1. 1

2. Life Finds A Way:Life Finds A Way:
Just Don’t Give UpJust Don’t Give Up

5. 5

8. ARIARI

10. SIGNS OF RESPIRATORY DISTRESSSIGNS OF RESPIRATORY DISTRESS

11. 11

13. 13

14. 14

15. 15
Definition of ARIDefinition of ARI (Acute Resp. Infection)(Acute Resp. Infection)
This term isThis term is usedused by HW to indicate ac. Inf. ofby HW to indicate ac. Inf. of
resp. system in U-5y childrenresp. system in U-5y children
In this age group such inf. are often not anatomicallyIn this age group such inf. are often not anatomically
localized, rather spreads rapidly to adjacent partslocalized, rather spreads rapidly to adjacent parts
An U-5 child getsAn U-5 child gets 3-6 ARIs/y3-6 ARIs/y regardless of livingregardless of living
standardstandard
HW: health worker. U-5: under 5 years of age. Inf.: infectionHW: health worker. U-5: under 5 years of age. Inf.: infection

16. 16
Clinical AnatomyClinical Anatomy
• RT is divided into 3 parts:RT is divided into 3 parts:
URT:URT: nosenose ⇒⇒tracheatrachea (PNS, mouth, tonsils,(PNS, mouth, tonsils,
pharynx, auditory T,pharynx, auditory T, mid-earmid-ear, larynx), larynx)
LRT:LRT: tracheatrachea⇒⇒ bronchibronchi ⇒⇒air ductsair ducts
Lung parenchymaLung parenchyma

17. 17

18. 18

19. 19

20. 20

21. 21
Normal Defence of RSNormal Defence of RS
These are unique!These are unique!
• Breathing, coughing, sneezingBreathing, coughing, sneezing
• Mucosal antibodiesMucosal antibodies
• Ciliary sweepingCiliary sweeping
• PhagocytesPhagocytes
• Physical filteringPhysical filtering
(Think how less often you catch cold and cough!)(Think how less often you catch cold and cough!)

22. 22
Physical filterPhysical filter

23. 23
Unique brooms!Unique brooms!

24. 24
ARI in ChildrenARI in Children Spread Rapidly:Spread Rapidly:
• Shorter and narrower RTShorter and narrower RT
• Cough not strongCough not strong
• Less immuneLess immune
• Auditory tube is:Auditory tube is:
– shortershorter
– narrowernarrower
– straighterstraighter

25. Sites of Infections (ARI)Sites of Infections (ARI)
• RhinitisRhinitis
• TonsillitisTonsillitis
• PharyngitisPharyngitis
• EpiglottitisEpiglottitis
• LaryngitisLaryngitis
• AOMAOM
• TracheitisTracheitis
• BronchitisBronchitis
• BronchiolitisBronchiolitis
• Pn./Br.PnPn./Br.Pn
Children usually have combinations:Children usually have combinations:
Ac. rhinopharyngotonsillitis +/- AOM, ac. LTBAc. rhinopharyngotonsillitis +/- AOM, ac. LTB
(croup) Br.Pn, etc.(croup) Br.Pn, etc.

26. 26
ARI is a syndrome:ARI is a syndrome:
– cough,cough, breath ratebreath rate
– chest indrawing,chest indrawing, stridorstridor
– +/-+/- 4 general4 general danger signdanger signs (IMCI)s (IMCI)
NoNo Dr,Dr, nono stethoscope,stethoscope, nono lab.!lab.!

27. 27
Normal breathing rateNormal breathing rate
AgeAge RRRR Fast breathingFast breathing
<2mo<2mo <60/min<60/min ≥≥6060
(preterm 70)(preterm 70)
2-12mo2-12mo <50/min<50/min ≥ 50≥ 50
1-5y1-5y <40/min<40/min ≥ 40≥ 40
Counting BreathingCounting Breathing
• The childThe child mustmust be calmbe calm
• Count full 1 minuteCount full 1 minute
• Count the abdominal swelling in inspirationCount the abdominal swelling in inspiration

28. Chest indrawing:Chest indrawing:
• Suprasternal, supraclavicular retraction/recessionSuprasternal, supraclavicular retraction/recession
• Intercostal spaceIntercostal space ,,,,
• SubcostalSubcostal ,,,,
44 General Danger signs:General Danger signs:
• Lethargic/unconsciousLethargic/unconscious
• Poor feeding/not feedingPoor feeding/not feeding at allat all
• Vomits everythingVomits everything
• ConvulsionConvulsion
28

29. 29
DANGER
SIGNS
CONVULSIONS
INABILITY TO DRINK
OR BREASTFEED
VOMITING
LETHARGY
UNCONSCIOUSNESS

30. 30
SS of ARI for DoctorsSS of ARI for Doctors
• Cold, sore throatCold, sore throat
• CoughCough,, sputumsputum
• Nasal flareNasal flare
• Chest indrawingChest indrawing
• StridorStridor,, voice change,voice change,
gruntinggrunting
• TachypnoeaTachypnoea
• CyanosisCyanosis
• Asymmetry of chest &Asymmetry of chest &
its movementits movement
• Tracheal deviationTracheal deviation
• Displaced heartDisplaced heart
• Auscultation:Auscultation:

31. 31
Auscultatory FindingsAuscultatory Findings
• Poor or unequal air entryPoor or unequal air entry
• Prolonged expirationProlonged expiration
• Wheeze/ronchiWheeze/ronchi
• Fine +/-coarse crepitationsFine +/-coarse crepitations
• Bronchial breath soundBronchial breath sound
• Post-tussive creps/or ronchiPost-tussive creps/or ronchi

32. 32

33. 33
Depth of ARI as ProblemDepth of ARI as Problem
• Pneumonia is the biggest U-5 killer (0.9million/y);Pneumonia is the biggest U-5 killer (0.9million/y);
90% in L&MICs (70% in Africa & SEA)90% in L&MICs (70% in Africa & SEA)
• Commonest admission (Commonest admission (12-45%)12-45%)
• OPD: 20-60% ARIOPD: 20-60% ARI
• V. imp. precipitator of Mn, VADXV. imp. precipitator of Mn, VADX
• NationalNational Health IndexHealth Index of a countryof a country
((5.9 million U-5 death in 2015: 16,000/d.5.9 million U-5 death in 2015: 16,000/d. 70% from inf.)70% from inf.)

34. 34
ARI
54%
Diarrhoea
85%
Malaria
79%
Measles
89%
Percentage of deaths occurring among:
Global Disease Burden Borne by U-5 (Y 2000)

35. Key facts:Key facts: PneumoniaPneumonia
•15% of all U-5 deaths:15% of all U-5 deaths: 900,000 in 2015900,000 in 2015
•Kills by hypoxia due to pus and fluid in alveoliKills by hypoxia due to pus and fluid in alveoli
•C/by viruses, bacteria or fungiC/by viruses, bacteria or fungi
•Rx with low-cost, low-tech drugs and care (1/3Rx with low-cost, low-tech drugs and care (1/3rdrd
childrenchildren
with pneumonia get AB)with pneumonia get AB)
•Preventable by immunization, nutrition & cleanPreventable by immunization, nutrition & clean
environmentenvironment
35

36. ARI mortality/morbidity highest in U-5yARI mortality/morbidity highest in U-5y
– Lack of breast feedingLack of breast feeding
– Bottle feeding, weaned earlyBottle feeding, weaned early
– HIVHIV
– <2y of age<2y of age
– Lack of vaccinationLack of vaccination
– Mn., VADXMn., VADX
– Poor education, overcrowding, poor clothingPoor education, overcrowding, poor clothing
– Difficult access to healthcare, medicationDifficult access to healthcare, medication

37. 37
Aetiology of ARIAetiology of ARI
• VirusesViruses
• BacteriaBacteria
• MycoplasmaMycoplasma
• FungusFungus
• Parasites, wormsParasites, worms

38. Aetiology …Aetiology …
• Varies: age, immune status, where contractedVaries: age, immune status, where contracted
• Community acquired (CAP)Community acquired (CAP)
– Developing countriesDeveloping countries
• VirusesViruses 40%40%
• S. pneumoniae, Hib, S aureus, Moraxella,S. pneumoniae, Hib, S aureus, Moraxella,
Mycoplasma, Chlamydia inMycoplasma, Chlamydia in 60%60%
– Developed countriesDeveloped countries
• Bacteria:Bacteria: 5-10%5-10%

39. Etiology Based on AgeEtiology Based on Age
AgeAge OrganismOrganism
NeonatesNeonates GBS, E coli, Klebsiella, SGBS, E coli, Klebsiella, S
aureusaureus
InfantsInfants Pneumococcus, Chlamydia,Pneumococcus, Chlamydia,
RSV, Hib, StaphRSV, Hib, Staph
1-5y1-5y Viruses, Pneumococcus, HibViruses, Pneumococcus, Hib
Chlamydia, Mycoplasma,Chlamydia, Mycoplasma,
Staph, GASStaph, GAS
5-18y5-18y Mycoplasma, Pneumococcus,Mycoplasma, Pneumococcus,
Chlamydia, HibChlamydia, Hib

40. 40
VirusesViruses
• RhinovirusesRhinoviruses
• RSVRSV
• AdenovirusesAdenoviruses
• Influenza, parainfluenza A B CInfluenza, parainfluenza A B C
• MyxovirusesMyxoviruses
• Corona viruses (SARS, MERS)Corona viruses (SARS, MERS)
• Boca virus, metapneumovirusBoca virus, metapneumovirus

41. 41
Common BacteriaCommon Bacteria
• **
S. pneumoniaeS. pneumoniae
• **
HibHib
• S. pyogenesS. pyogenes
• S. aureusS. aureus
• **
M. tuberculosisM. tuberculosis
• **
C diphtheriaeC diphtheriae
• Enteric bacilliEnteric bacilli
• PseudomonasPseudomonas
• KlebsiellaKlebsiella
• MoraxellaMoraxella
*Vaccine available

42. 42
Others
• Chlamydia
• Mycoplasma
• Fungus: C. albicans, Histoplasma
• Miscellaneous: P. carinii, worms

43. 43
How ARI HarmsHow ARI Harms
• Malnutrition andMalnutrition and VADX:VADX:
• HypoxiaHypoxia:: convulsion, deathconvulsion, death
• ChestChest: collapse, consolidation, effusion, L. abscess,: collapse, consolidation, effusion, L. abscess,
bronchiectasis, pneumothoraxbronchiectasis, pneumothorax
• Blood:Blood: sepsis, deranged ABB, dyselectrolytemia,sepsis, deranged ABB, dyselectrolytemia,
meningitis, IgA nephropathymeningitis, IgA nephropathy
VADX: Vitamin A defi. And xerophthalmiaVADX: Vitamin A defi. And xerophthalmia

44. 44
ARI Causes Mn. and VADXARI Causes Mn. and VADX
• Poor feedingPoor feeding
• Negative nitrogen balanceNegative nitrogen balance
• VD, F: dehydrationVD, F: dehydration
• Exhaustion of VAExhaustion of VA
• Faulty feeding, tabooFaulty feeding, taboo
Mn.: Malnutrition. VD: vomiting diarrhoea. F: fever. VA: vitamin AMn.: Malnutrition. VD: vomiting diarrhoea. F: fever. VA: vitamin A

45. 45
Dehydration in ARIDehydration in ARI::
• fast breathingfast breathing
• FF
• NVDNVD
• runny noserunny nose
• poor/faulty feedingpoor/faulty feeding
NVD: nausea vomiting diarrheaNVD: nausea vomiting diarrhea

46. 46
How ARI killsHow ARI kills
AcuteAcute
• HypoxiaHypoxia
• HHypoglycemia, convulsion, cardiac failureypoglycemia, convulsion, cardiac failure
• Septicemia, dehydrationSepticemia, dehydration
LateLate
• Mn., VADXMn., VADX
• Suffocation, aspirationSuffocation, aspiration

47. 47
Hospital PictureHospital Picture
• Out of 1690 cases admitted in BMCH pediatricOut of 1690 cases admitted in BMCH pediatric
ward 400 (23.7%) had ARIward 400 (23.7%) had ARI
• Peak incidence during Oct-NovPeak incidence during Oct-Nov

48. 48
Death from ARI is DecliningDeath from ARI is Declining**
• Br. FeedingBr. Feeding
• No bottle feedingNo bottle feeding
• Socioeconomic &Socioeconomic &
environmental changeenvironmental change
• Falling Mn.Falling Mn.
• HPVAC distributionHPVAC distribution
• EPIEPI
• Family planningFamily planning
• Modern health careModern health care
• Better and cheap drugsBetter and cheap drugs
• Female literacyFemale literacy
• Health awarenessHealth awareness
*
Previously 4mn, now 0.9Previously 4mn, now 0.9

49. ManagementManagement
According toAccording to
IMCIIMCI[[[[
IMCI: integrated management of childhood illnessesIMCI: integrated management of childhood illnesses

50. History TakingHistory Taking
1. General Danger Signs1. General Danger Signs
2. Main Symptoms2. Main Symptoms
a. Cougha. Cough
b. Diarrheab. Diarrhea
c. Feverc. Fever
d. Ear Problemsd. Ear Problems
3. Nutritional Status3. Nutritional Status
4. Immunization Status4. Immunization Status
5. Other Problems5. Other Problems
IMCI Record FormIMCI Record Form

51. 51
Assess whether the child hasAssess whether the child has
• No pneumonia (cold-cough; chr. cough)No pneumonia (cold-cough; chr. cough)
• Pneumonia orPneumonia or
• Severe Pn.Severe Pn.
In babies <2mo any pneumonia is severe pn.In babies <2mo any pneumonia is severe pn.

52. 52
Fast breathing +Fast breathing +
chest indrawing orchest indrawing or
Stridor in a calmStridor in a calm
child. (Any GD sign)child. (Any GD sign)
SevereSevere PneumoniaPneumonia
oror
(Very Severe Disease)(Very Severe Disease)
Fast breathingFast breathing PneumoniaPneumonia
No signs ofNo signs of
pneumonia or verypneumonia or very
severe diseasesevere disease
No pneumonia:No pneumonia:
cough or coldcough or cold

53. 53
Limitations …Limitations …
Pneumonia in IMCI may bePneumonia in IMCI may be
• BronchiolitisBronchiolitis
• Br. AsthmaBr. Asthma
• DiphtheriaDiphtheria
• PertussisPertussis
• HGF, CCFHGF, CCF
No pneumonia may be TBNo pneumonia may be TB

54. PneumoniaPneumonia
• Fast breathingFast breathing
• Inflam. of lung parenchyma + consolidationInflam. of lung parenchyma + consolidation
• Developed world:Developed world: viral:viral: Low morbidity mortalityLow morbidity mortality
• Developing world:Developing world:
– Bacteria in 65%Bacteria in 65%
– Cheap, oral ABT: Amoxicillin can causeCheap, oral ABT: Amoxicillin can cause 84%84%
reduction in deathreduction in death

55. 55
Severe PneumoniaSevere Pneumonia
• Very sick,Very sick, not able to feednot able to feed
• Tachypnoea,Tachypnoea, tachycardiatachycardia
• Chest indrawingChest indrawing
• Creps, wheezeCreps, wheeze
• Cyanosis, convulsionCyanosis, convulsion
• DrowsinessDrowsiness
+/- Fever+/- Fever

56. 56
Lab. Dx. of PneumoniaLab. Dx. of Pneumonia
(not for HW/IMCI)(not for HW/IMCI)
• CXRCXR
• CBC filmCBC film
• CS of blood, tracheal and lung aspirateCS of blood, tracheal and lung aspirate
• Throat swabThroat swab

57. 57
S. pneumoniae

58. 58
Pneumococcal pneumoniaPneumococcal pneumonia
R upper lobe consolidation with Air BronchogramR upper lobe consolidation with Air Bronchogram

59. 59

60. 60

61. 61
Air-fluid level in Lung Abscess. Note small free PE inAir-fluid level in Lung Abscess. Note small free PE in
R pleural cavityR pleural cavity

63. Complications of pneumoniaComplications of pneumonia
IntrathoracicIntrathoracic
• P. effusion, empyemaP. effusion, empyema
• Collapse, consolidationCollapse, consolidation
• L. abscess, pneumatoceleL. abscess, pneumatocele
• PneumothoraxPneumothorax
ExtrathoracicExtrathoracic
• Septicemia, meningitisSepticemia, meningitis
• DehydrationDehydration
• Myocarditis, pericarditisMyocarditis, pericarditis
• Acidosis, dyselectrolytemiasAcidosis, dyselectrolytemias

64. 64

65. 65

66. 66
Consolidated lungConsolidated lung

67. 67
Rx: General PrinciplesRx: General Principles
• O2, air way careO2, air way care
• Nebulized beta-agonist, anticholinergicNebulized beta-agonist, anticholinergic
• Antibiotics (parenteral)Antibiotics (parenteral)
• Feeding, warmth, FEBFeeding, warmth, FEB
• Vitamin A, ZnVitamin A, Zn
• Counseling, FUCounseling, FU

68. 68
Rx. Severe PneumoniaRx. Severe Pneumonia
• Admission,Admission, OO22
• Airway patency:Airway patency:
– suction clearancesuction clearance
– Nebulized bronchodilator, anti-secretoryNebulized bronchodilator, anti-secretory
• Parenteral ABParenteral AB
• Lowering HGFLowering HGF
• Feeding, FEB, warmthFeeding, FEB, warmth
• Vitamin A, zincVitamin A, zinc

69. 69
Antibiotics in PneumoniaAntibiotics in Pneumonia
Mostly viral but 2y infx. is commonMostly viral but 2y infx. is common
• Injectable: usuallyInjectable: usually >1 AB>1 AB
• Minimum 10dMinimum 10d
• Penicillin +genta/amikacin are goodPenicillin +genta/amikacin are good
• Staph coverage for babies <2yrStaph coverage for babies <2yr

70. 70
When You Defer ABWhen You Defer AB
• The child is stable, playful, no HGFThe child is stable, playful, no HGF
• EBF, no bottle feedingEBF, no bottle feeding
• Taking feeds normallyTaking feeds normally
• SupervisedSupervised

71. 71
Rx for Cough and Cold (no pn.)Rx for Cough and Cold (no pn.)
• Exclude AOMExclude AOM
• Ensure feedingEnsure feeding
• Treat feverTreat fever
• Clean noseClean nose
• Steam therapySteam therapy
• Honey+tulsiHoney+tulsi
Chr./rec. CoughChr./rec. Cough
• TB?TB?
• Congenital HD?Congenital HD?
• FB?FB?
• Reactive airway?Reactive airway?
• GERD?GERD?

72. 72

73. 73
Follow up for PneumoniaFollow up for Pneumonia
• Count breath (most important single sign)Count breath (most important single sign)
• Watch activities: smiles, plays, feeds. Urine outputWatch activities: smiles, plays, feeds. Urine output
If the child stays at homeIf the child stays at home
• Teach mom how to observe SoB, count breathTeach mom how to observe SoB, count breath
• Nose cleaning, feeding, warmthNose cleaning, feeding, warmth
• Ask to return immediately:Ask to return immediately:
s/of deterioration (fast br., chest indrawing)s/of deterioration (fast br., chest indrawing)
poor feedingpoor feeding

74. 74

75. 75
HumidificationHumidification

76. 76
Prevention of ARIPrevention of ARI
• Breast feedingBreast feeding
• No feederNo feeder
• ImmunizationImmunization
• HPVAC, ZincHPVAC, Zinc
• Rx malnutritionRx malnutrition
• Warmth, warm clothingWarmth, warm clothing
• No air pollutionNo air pollution
• No smokingNo smoking
• Female literacyFemale literacy
• Family Planning,Family Planning,
birth spacingbirth spacing
• SanitationSanitation
• No overcrowdingNo overcrowding

77. 77

78. ACUTE EPIGLOTTITISACUTE EPIGLOTTITIS
• Life-threatening inf. of epiglottis,Life-threatening inf. of epiglottis,
aryepiglottic folds & arytenoidaryepiglottic folds & arytenoid
(sudden suffocation)(sudden suffocation)
• mostly in wintersmostly in winters
• peak :-1–6 y old. M:F 3:2peak :-1–6 y old. M:F 3:2
• Commonly bacteria: Hib. Concomitant bacteremia, pn.,Commonly bacteria: Hib. Concomitant bacteremia, pn.,
AOM, arthritis, etc. by Hib may be presentAOM, arthritis, etc. by Hib may be present

79. 79

80. ACUTE EPIGLOTTITISACUTE EPIGLOTTITIS
aka supraglottitisaka supraglottitis
CFCF
– HGF, sore throat, SoB, rapidlyHGF, sore throat, SoB, rapidly
progressing res. obstructionprogressing res. obstruction
– toxic, dysphagia, chest indrawing, drooling,toxic, dysphagia, chest indrawing, drooling,
hyper extended neck, tripod positionhyper extended neck, tripod position
– stridor is a late finding; cyanosis, coma, deathstridor is a late finding; cyanosis, coma, death
– mouth is open, jaw thrust forwardmouth is open, jaw thrust forward ((sniffingsniffing
positionposition).). Barking cough is rareBarking cough is rare

81. EXAMINATIONEXAMINATION
• Do notDo not examine the throatexamine the throat
• Assess severityAssess severity
– degree of stridor, resp. rate, HRdegree of stridor, resp. rate, HR
– pulse oximetry, arousalpulse oximetry, arousal
• Dx:Dx:
– ““cherry red” epiglottischerry red” epiglottis
– ‘‘thumb sign’ on lateral neck XRthumb sign’ on lateral neck XR
– blood cultures, electrolytesblood cultures, electrolytes

82. • Direct laryngoscopy:Direct laryngoscopy: cherry redcherry red epiglottisepiglottis
But not recommended!But not recommended!
ACUTE EPIGLOTTITIS …ACUTE EPIGLOTTITIS …

83. Lateral neck XR:Lateral neck XR:
(thumb sign)(thumb sign)

84. Rx (AC. EPIGLOTTITIS)Rx (AC. EPIGLOTTITIS)
A medical emergency!A medical emergency!
• ICUICU
• endotracheal intubation may be neededendotracheal intubation may be needed
• help from anesthetist & ENT surgeonhelp from anesthetist & ENT surgeon
• IV Amplicillin/Ceftriaxone (100 mg/kg/d) x10dIV Amplicillin/Ceftriaxone (100 mg/kg/d) x10d
• O2, ABB, IVF, nutritionO2, ABB, IVF, nutrition
• Rifampicin prophylaxis to close contactsRifampicin prophylaxis to close contacts

85. ALTB (croup)ALTB (croup)
• Mucositis of glottis-subglottisMucositis of glottis-subglottis;; usually viral:usually viral:
parainfluenza 1,2,3 (75%),parainfluenza 1,2,3 (75%), influenza A,B; RSV,influenza A,B; RSV,
epiglottitis, diphtheriaepiglottitis, diphtheria
• TracheitisTracheitis
• Age : 6mo–6yAge : 6mo–6y
ALTB: Ac. LaryngotracheobronchitisALTB: Ac. Laryngotracheobronchitis (CROUP)(CROUP)

86. • Inflam. swelling of throat: classical:Inflam. swelling of throat: classical: stridorstridor,,
"barking" cough"barking" cough,, hoarsenesshoarseness (within 1-2d)(within 1-2d)
• Features of URTI + croupFeatures of URTI + croup
• LGF, Prolonged inspirationLGF, Prolonged inspiration
• Severe at night, on lyingSevere at night, on lying
• Relieved by sitting upRelieved by sitting up
• Neck XR: subglotticNeck XR: subglottic
narrowingnarrowing (Steeple sign)(Steeple sign)

87. Dx: mainly clinical. XRDx: mainly clinical. XR
neck: steeple signneck: steeple sign
(unreliable)(unreliable)

88. DD of croup:DD of croup:
• ALTBALTB
• Ac. infectious laryngitisAc. infectious laryngitis
• Ac. epiglottitisAc. epiglottitis
• Spasmodic croupSpasmodic croup
• Bacterial tracheitisBacterial tracheitis
• DiphtheriaDiphtheria
• Measles croupMeasles croup
Ac. Laryngotracheobronchitis (ALTB)Ac. Laryngotracheobronchitis (ALTB)

89. DD: Ac. LTB and Ac. EpiglottitisDD: Ac. LTB and Ac. Epiglottitis
CroupCroup EpiglottitisEpiglottitis
CourseCourse daysdays hourshours
ProdromeProdrome coryzacoryza nonenone
CoughCough barkingbarking slight if anyslight if any
FeedingFeeding ableable nono
MouthMouth closedclosed droolingdrooling
ToxicToxic nono yesyes
FeverFever <38.5<38.500
CC >38.5>38.5 00
CC
StridorStridor raspingrasping softsoft
VoiceVoice hoarsehoarse Weal/silentWeal/silent

90. ALTB: RxALTB: Rx
• humidified airhumidified air
• steroidssteroids
• reduce severity and duration/need forreduce severity and duration/need for
intubationintubation
•Prednisolone p.o. 2mg/kg/d x3dPrednisolone p.o. 2mg/kg/d x3d
• nebulized budesonidenebulized budesonide
• nebulized adrenalinenebulized adrenaline

91. • Very common in childrenVery common in children
• Age: 2-6 mo. C/by:Age: 2-6 mo. C/by:
– S. pneumoniaeS. pneumoniae, Hib, M. catarrhalis, Hib, M. catarrhalis
Symptoms:Symptoms:
• earache,earache, inconsolable cryinconsolable cry & sleep disturbances, fit,& sleep disturbances, fit,
sometimes DVsometimes DV
Signs:Signs:
• Otorrhea or bulged congested TM, PEDOtorrhea or bulged congested TM, PED
PED: perforated eardrumPED: perforated eardrum

92. 92

93. 93

94. DxDx
• History, autoscopyHistory, autoscopy
• MyringotomyMyringotomy
• CBC, pus CSCBC, pus CS
94

95. TreatmentTreatment
•Broad-spectrum ABTBroad-spectrum ABT
•Analgesic, decongestant (local/systemic)Analgesic, decongestant (local/systemic)
• Saline nose washSaline nose wash
•Myringotomy SOSMyringotomy SOS
•Local AB drop for PEDLocal AB drop for PED
•No bath in PEDNo bath in PED

96. Complications of OMComplications of OM
• MastoiditisMastoiditis
• MeningitisMeningitis
• Brain abscessBrain abscess
• PEDPED
• Deafness-dumbness, poor learningDeafness-dumbness, poor learning
• ConvulsionConvulsion
96

97. 97
MCQMCQ
• HPVAC is an important intervention to prevent ARIHPVAC is an important intervention to prevent ARI
• Feeding bottle is a baby killerFeeding bottle is a baby killer
• Cut-off mark of fast breathing at 9 mo is 40Cut-off mark of fast breathing at 9 mo is 40
• Any pneumonia in <6o-days of age is severe pn.Any pneumonia in <6o-days of age is severe pn.
• O2 is the most important Rx for severe pn.O2 is the most important Rx for severe pn.

98. MCQMCQ
• Parenteral ABT is recommended for severe pn.Parenteral ABT is recommended for severe pn.
• Zn has an imp. role in shortening of duration &Zn has an imp. role in shortening of duration &
prevention of recurrence of ARI in childrenprevention of recurrence of ARI in children
• Commonest c/of ac. epiglottitis is HibCommonest c/of ac. epiglottitis is Hib
• Ac. epiglottitis is usually Dx by direct laryngoscopy
• Croup means stridor, hoarseness, barking cough
98

100. 100
Next:
Diarrhea