Supportive treatment hydrate eat Does not require antibiotics but the secondary

Supportive treatment hydrate eat does not require

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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
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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
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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
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Born with it (congenital) Three classic signs: Cyanosis
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