Term
| Respiratory Syncytial Virus (RSV) |
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Definition
Pneumovirus Type A & B - highly contagious;
most prevalent pathogen in early childhood --> bronchiolitis & pneumonia;
66% affected in 1st yr; 100% infected by 2nd yr; |
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Term
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Definition
Adults & Adolescents: common cold w/ significant sinus drainage - NOT life threatening;
Children: starts as upper respiratory infection, progresses to lower respiratory infection that may require hospitalization |
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Term
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Definition
severe outbreaks occur annually and last for 5 months;
in US, occurs from Nov - March;
can occur year round, just not at epidemic levels;
infection does not protect from future illness; |
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Term
| Risk Factors for RSV Infection - requires preventative tx for these pts |
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Definition
1) children < 2 yrs w/ chronic lung dx;
2) children < 2 yrs w/ congenital heart dx (CHF, pulmonary HTN, cyanotic heart dx);
3) children born before 35 weeks w/ congenital abnormalities of airways or neuromuscular dx;
4) Premature infants born < 28 wks & who are < 12 months old at start of RSV season;
5) Premature infants born between 29-32 weeks & who are < 6 months old at start of RSV season;
6) Premature infants born between 32-35 wks & who are less 3 months old at start of season AND have 1 of following: attend daycare, have a sibling < 5 yrs old at home; |
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Term
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Definition
nonspecific;
low-grade fever (<101.5);
irritability;
lethargy;
poor feeding;
apnea; |
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Term
| Clinical Presentation of RSV |
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Definition
rhinorrhea & congestion, fever;
cough, dyspnea, wheezing;
tachycardia, tachypnea, nasal flaring, retractions & difficulty breathing, chest X-ray w/ hyperinflation & atelactasis |
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Term
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Definition
MAINSTAY of THERAPY;
- will resolve on own as long this is done;
Mild - treat at home;
If pt has apnea, desaturation, retractions, or tachypnea: hospitalize;
Includes:
- humidified O2, IV fluids, monitoring O2 saturation, & possible mechanical ventilation |
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Term
| bronchodilators in RSV tx - children < 2 yrs use racemic Epi; older children use albuterol |
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Definition
widely used in past, not proven to be efficacious;
- clinically still used to see if pt benefits from their use;
- used to tx reactive airway dx (RAD) in certain pt w/ viral trigger |
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Term
| corticosteroids in RSV tx |
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Definition
| these drugs have not shown efficacy in tx |
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Term
| Emerging therapies in tx of RSV |
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Definition
inhaled hypertonic saline;
combo therapy w/ racemic Epi & dexamethasone; |
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Term
| ribavirin (Copegus, Virazole, Rebetol) |
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Definition
only drug w/ FDA indication for tx of RSV;
questionable efficacy (20-30% success rate);
- must be started w/in 72 hrs of onset of infection;
Dose: 6 g/day via nebulizer over 12-18 hrs for 3-14 days (7 days standard), dilute to conc. of 20 mg/ml;
TERATOGENIC!!!
ADRS: well tolerate, wheezing, rash, conjunctivitis, reticuloctosis, anemia; |
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Term
| Resolution of RSV Infection - very slow improvement |
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Definition
Mild: 5-7 days;
Moderate: 1-2 wks;
Severe: up to 3 wks; |
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Term
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Definition
indicated for highest risk pts ONLY!
- given monthly during RSV season;
- Respigam (RSV IVIG) & Synagis (palivizumab) |
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Term
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Definition
polyclonal antibody from pooled plasma (passive immunity) --> hypersensitivity RXNs!!!
- Dose: 750 mg/kg (15 mL/kg) IV monthly over several hrs;
Efficacy: decreased infections requiring hospitalization by 41%;
Disadv: increased likelihood of infusion related rxns, possible fluid overload, high nursing needs, high drug & administration costs; |
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Term
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Definition
monoclonal antibody via recombinant DNA;
Dose: 15 mg/kg IM monthly for 5 months during RSV season;
ADRs: site rxns;
Efficacy: 56% reduction in RSV-related hospitalizations;
ADV: low nursing needs, no risk of fluid overload, drug cost is high but low administration costs;
Disadv: limited success in immunocompromised pts; |
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Term
| Croup - viral croup (laryngotracheobroncitis), epiglottitis (supraglottitis), bacterial tracheitis (pseudomembranous croup) |
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Definition
| general name for inflammatory dx of larynx |
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Term
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Definition
most commonly caused by parainfluenza;
affects younger children in fall & early winter;
inflammation of entire airway but edema of subglottic space causes signs of upper airway obstruction;
Prodrome: URTI;
S/Sx: barking-like cough, stridor, NO or low-grade fever, Severe: stridor at rest, air hunger, cyanosis; |
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Term
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Definition
| manage at home w/ oral rehydration, minimal handling, +/- mist therapy; |
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Term
| Tx of Moderate-Severe Viral Croup |
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Definition
If stridor at rest is present:
- O2 (intubate if respiratory collapse near);
- racemic Epi 2.25% soln: 0.05 mL/kg up to 1.5 mL diluted in equal amount NS (reduce inflammation);
- dexamethasone 0.6 mg/kg IM for 1 dose only --> improves sx & decreases hospitalizations & intubations |
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Term
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Definition
TRUE MEDICAL EMERGENCY!!! - obstruction of airway;
Caused by H. influenzae B;
S/Sx: sudden onset - FEVER, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis & soft stridor, "sniffing-dog position", cherry red & swollen epiglottis;
- potential total airway obstruction & respiratory arrest; |
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Term
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Definition
Endotracheal intubation immediately!!!
- culture blood & epiglottis;
Antibiotic to cover H. influenzae:
- ceftriaxone 150 mg/kg/day in two doses;
- change to oral cephalosporin once improved to finish a 10-day course |
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Term
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Definition
severe form of laryngotracheobronchitis;
caused most often by Staph. Aureus --> inflammatory edema, purulent secretions, pseudomembranes;
S/Sx:
Early - develop HIGH fever, toxic look, progressive airway obstruction
High incidence of sudden respiratory arrest or progressive respiratory failure;
- increased white cell count w/ left shift present;
- cultures of trachea are positive bu blood cultures negative |
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Term
| Tx of Bacterial Tracheitis |
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Definition
Intubation is necessary;
Antibiotic coverage for Staph. Aureus & H. influenzae:
- traditional: cefotaxime;
- if CA-MRSA is highly prevalent: clindamycin;
- if pt is highly toxic or Multiple organ involvement: vancomycin |
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