Supportive treatment – hydrate, eat Does not require antibiotics, but the secondary infection might! Tonsillitis Inflammation of palatine tonsils Sore throat Difficulty swallowing Mouth breathing with halitosis May cause airway obstruction Often viral
90% all sore throats are viral Can be caused by group A strep (strep throat) o Antibiotics – MUST finish all abx o Sterilize/Replace toothbrush – after on abx for 24 hours Tonsil Grading Scale o Tonsils can each be different size o 4+ usually causes some degree of sleep apnea due to obstruction Tonsillectomy and Adenoidectomy (T&A) o Can be done together or separate o Must have at least seven documented cases of strep or tonsillitis in one year o Must have a sleep study done to determine the degree of sleep disruption due to large tonsils/adenoids o Removal: 6-7 cases of strep/year documented Documented sleep study with difficulty Snoring, obstruction, apnea o Behavioral problems – restless when tired o Tonsil and adenoid tissue can grow back o Adenorid further back Post Op T&A o Bleeding – high risk, vascular area – at least a night for observation Internal surgery, no dressing – increased swallowing – teach parents to watch Changed in VS – HR ↑ , BP ↓ o Hydration o Pain ( avoid ibuprofen : increases bleeding) Keep under control – fussy irritable Morphine, Tylenol, motrin o Respiratory Rate - ↑ if bleeding o Pulse o Ice Collar - vasoconstrict o Control Nausea – Zofran; vomit = bleeding & germs o Avoid Coughing Vomiting Crying Straws Acidic foods/drinks Which of the following assessment findings on a child who had a T&A is most concerning? oFrequent swallowingoPain 4/10 in the throatoAnorexiaoWet diapers every 2 hoursEpiglottitis
EMERGENT SITUATION Bacterial infection of the epiglottis that causes severe edema and blockage of the airway Infections organisms: o Haemophilus influenzae B (note…this is a bacteria) #1 cause – we vaccinate for this now – rare to see any more o Streptococcus o Staphylococcus Sx Well child becomes ill rapidly Fever (>39 C) DROOLING – focused on breathing, don’t control breathing Sore throat Tripod positioning No cough Quiet & Irritable – air hungry Hoarseness and muffled voice Cardinal Signs of Epiglottitis (4 D’s) Dysphonia Dysphagia Drooling Distressed respiratory effort Epiglottitis Do NOT: o Attempt to place the child in a supine position o Stress the child o Attempt to visualize the mouth and throat o Place anything in the mouth (such as a tongue blade) Epiglottitis Treatment Prep for Intubation (tube vs. trach) Emergent trach tray at bedside Call ENT, anesthesia, respiratory therapist at bedside if throat examined by physician o Usually come in ER then get the ball rolling o Admitted to ICU Antibiotics Fluids Antipyretics Pain management Tracheoesophageal Fistula (TEF) Abnormal opening / communication between trachea and esophagus Isolated or in addition to esophageal atresia (EA) May affect ventilation History of polyhydramnios in utero Surgical repair hours to days after birth
Born with it (congenital) Three classic signs: Cyanosis
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- Spring '17