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Pediatrics(2)

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-Possibility of septicaemia.

-Acute clinical deterioration.

-High white cell count.

-Progressive infiltrative changes on chest radiograph.

-Give oral or parenteral antibiotics for 5 days based on severity and/or condition of the patient as follow:

• Amoxicillin 25mg per dose/kg/day Q12hr PO Or

• Ampicillin injections IM: 100 mg/kg/day in 3 divided doses or

-Alternative treatment:

• Erythromycin 30 -50 mg per dose/kg/day x3/day/7-10days

Note: Evidence on Treatment of bronchospasms does not support routine use of bronchodilators, steroids or antibiotics.

If bronchodilators are to be used, closely monitor effect as it might worsen respiratory distress

1.3.2. Asthma

Definition: Asthma is a chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction.

Causes

- Unknown but the following factors have been identified:

•Allergens (e.g., house dust, perfumes, food, animal airs, mites)

Medicine (e.g., propranolol and aspirin)

Environmental (e.g., change of weather, polluants), Infections (viral or bacterial)

Emotions

Family history (genetic factors)

• Gastro-esophageal reflux Signs and Symptoms

-

-

-

Breathlessness

-Wheezing/ prolonged expiratory

-Cough (chronic nocturnal cough)

-Exercise induced cough

-Chest tightness

-Sputum production

Signs and Symptoms

Note: Asthma can often be diagnosed on the basis of a patient’s symptoms and medical history.

Presence of any of these signs and symptoms should increase the suspicion of asthma:

-Wheezing high-pitched whistling sounds when breathing out-especially in children.

-History of any of the following:

Cough, worse particularly at night

Recurrent wheeze

Recurrent difficult breathing

Recurrent chest tightness

Symptoms occur or worsen at night, awakening the patient

Symptoms occur or worsen in a seasonal pattern

The patient also has eczema, hay fever, or a family history of asthma or atopic diseases

- Symptoms occur or worsen in the presence of:

Animals with fur

Aerosol chemicals

Changes in temperature

domestic dust mites

drugs (aspirin, beta blockers)

Exercise

Pollen

Respiratory (viral) infections

Smoke

Strong emotional expression

-Symptoms respond to anti-asthma therapy

-Patients colds “go to the chest” or take more than 10 days to clear up

Complications

-Uncontrolled/poorly controlled asthma can lead to severe lung damage

-Severe asthma exacerbation can cause respiratory failure and death

Investigations

-Lung function to confirm diagnosis and assess severity

-Peak expiratory flow rate can help diagnosis and follow up

-Additional diagnostic tests

Allergy testing (where applicable)

Chest X-ray (for differential diagnosis)

FBC for exclusion of super-infection Management

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