The document discusses a child recovering from dengue hemorrhagic fever (DHF) who exhibits respiratory distress and various pulmonary complications. It outlines the features and severity of respiratory issues such as stridor, tachypnea, and signs of bronchiolitis or bronchiectasis. The assessment criteria include respiratory effort, efficacy, and effects on the central and cardiovascular systems.

1. Why persistent?
Nearby spacer/MDI/ DPI
3. Pleural effusion with some respiratory
distress probably a child who is
recovering from DHF.
Why recovering from DHF?
Recovery rash, flushing, 2
cannula either side
Why respiratory distress?
Tachypnea. So COUNT RR/HR
Respiration short cases
BA
Bronchiolitis
PE
Bronchiectasis
1.
2.
3.
4.
Pathology
Severity
Acute/chronic
Complications: FTT/ HF
Pathology
1. Upper airway: stridor
2. Lower airway: U/L or B/L diffuse or
localized
3. Pleural effusion
4. Systemic: Pleural effusion in DHF pt
who is recovering (NOT just dengue
fever)
Emphysematous chest,
B/L rhonchi,
Eczema → BA
If clubbing + → can’t be BA. May be
bronchiectasis/ chr lung Dx
Features of hyperinflation (→bronchiolitis)
1. Barrel shaped chest
2. Hyper-resonant over the liver
3. Hyper-resonant over the heart
Severity: Effort, Efficacy, Effects
Effort
1. Recessions
2. Respiratory rate
3. Stridor
4. Grunting
5. Accessory muscles use
6. Flare of Alea nasi
Efficacy
1. Air entry – silent chest is a dangerous
sign.
2. Chest expansion
3. Cyanosis, hypoxia (pulse oxymeter,
92%)
Effects
1. CNS -Drowsy, agitation
2. CVS – Pallor, bradycardia, tachycardia.
Why do you say this is severe asthma?
Comprehensive diagnosis-e.g.
1. Moderately severe bronchiolitis in a
child with FTT.
2. BA with mild distress in a child
probably with persistent asthma who
has an eczema as well.
Yapa Wijeratne