Respiratory

case
Salman, 3130300488
Male, 3-month-old,
Date of admission: Dec
20th, 2015
Chief complaint: cough
for 3 days and
tachypnea for 1 day.
 Present illness: 3 days ago, he began to
cough with a running nose. 1 day ago, he
became severe with tachypnea and
wheezing. He had no fever, vomiting or
diarrhea, with bad appetite. Two other
members of the family had a runny nose
and sneezed.
 Past history: previously healthy.
 Personal history: He received inoculation
on schedule after birth.
 Family history: negative.
 Physical examination: T 36.8℃, R 68/min, P
140 /min. Nasal flaring, intercostal and
subcostal retractions and circumoral
cyanosis. Diffuse wheezing on both sides
of the lung. Regular heart rate. No
murmur. Liver is palpable 2cm below the
right costal margin. No abnormal nervous
system signs. Arterial oxygen saturation:
87%.
 Laboratory examination: Blood Routine:
WBC 5.0*109/L (5,000/mm3 ) with
lymphocyte 72%. CRP 2mg/L( normal ＜
8mg/L).
The diagnosis and the
differential
Asthma
Whooping cough (pertussis)
Pneumonia
Bronchiolitis
Athma
 Wheeze
 Tachpnea
 Cyanosis
 cough
However
 Patienthas no signs of eczema
 No indication of other family members
having asthma
Further investigations
 Family member?
 Environment: smoking,pets,farm.
 Skin prick testing
Pertussis
Caused by a gram negative bacteria
Three sages:
1] catarrhal- low grade fever and coryza
2] paroxysmal- intense cough following
inspiratory whoop, posttutive vomiting
3] convalescent- gradual recovery of
chronic cough
Other findings:

Lymphocytosis(15,000/mm3
)

Infants will have apnoea

rather than whoop
Further investigations
 Per nasal swab
Pneumonia
 Bacterial or viral
 In infants mainly caused by RSV(
respiratory syncytial virus), but also
bacterial infection such as S.pneumonia
or H. inflenza, bordetella and chlamydia.
Symptoms and examination
 cough
 Nasal flaring
 Tachypnea
 Wheezing
 Low O2 saturation
 fever
 Coarse crackles over affected area
 Consolidation and dullness
however
 is usually unilateral and not bilateral
 Its not diffused
Consolidation
Further investigations
 X-ray
 Percusion
Bronchiolitis
 Inflammation of bronchioles
 During winter
 Age 1-9 months
 Mainly due to RSV but could be from rhino
virus and adenovirus
Symptoms and findings
 Dry cough
 Tachypnea
 Intercostal recession
 Hyperinfalted chest – liver
displacement(more than 2cm below the
right costal margin)
 Crackles, wheeze
 Tachycardia and cyanosis
Further evaluation
 X-ray
 Nasopharyngeal secretion (pcr)
Treatment , management
 Facemask CPAP
 Fluids given intravenously or nasogastric
tube
Prevention

 Goodhand hygeine
 Monoclonal antibody to RSV(palivizumab)