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🧸 Pediatrics · Aralin 2 sa 5 · 7 min

Croup, Epiglottitis, at ang Tongue Blade na Hindi Mo Dapat Gamitin

Croup, Epiglottitis and the Tongue Blade You Never Use

🐕 Ang tumatahol na ubo sa alas-2 ng madaling araw ay croup, at ginagamot ito ng isang dose ng dexamethasone. Ang tahimik, naglalaway, at takot na takot na batang nakaupo nang nakasulong ay epiglottitis, at ang tongue blade na kukunin ng isang nurse na may mabuting layunin ay maaaring tuluyang magsara ng airway.

🐕 A barking cough at 2 a.m. is croup, and a dose of dexamethasone treats it. A silent, drooling, terrified child sitting forward is epiglottitis, and the tongue blade a well-meaning nurse reaches for can close the airway for good.

💡 Pangunahing ideya

Ang croup ay tumatahol at binibigyan ng steroid, kasama ang nebulized epinephrine para sa stridor habang nagpapahinga. Ang epiglottitis ay naglalaway, nakaupo nang nakasulong, at nangangailangan ng airway team, hindi kailanman tongue blade. Ang RSV ay suction at contact precautions. Ang CF ay enzymes sa bawat subo.

Croup barks and gets a steroid, plus nebulized epinephrine for stridor at rest. Epiglottitis drools, sits forward and gets an airway team, never a tongue blade. RSV gets suction and contact precautions. CF gets enzymes with every bite.

🧠 Bakit mahalaga

CROUP (laryngotracheobronchitis): viral, na may tumatahol na ubo, inspiratory stridor, pamamaos, at mababang lagnat, na lumalala sa gabi; gamutin ng corticosteroid (oral dexamethasone) at, para sa stridor habang nagpapahinga, nebulized racemic epinephrine, habang pinapanatag ang bata kasama ang magulang; ang cool mist o malamig na hangin sa gabi ay maaaring makapagpaginhawa sa bata ngunit hindi ito gamot sa croup. EPIGLOTTITIS: bacterial (karaniwan ay Haemophilus influenzae type b, na bihira na ngayon dahil sa vaccination), na may biglaang mataas na lagnat, ang apat na D (drooling, dysphagia, dysphonia, distress), tripod position, at walang ubo; HUWAG suriin ang lalamunan, gumamit ng tongue blade, o ihiga nang patag ang bata; panatilihing kalmado, nakaupo, at kasama ang magulang ang bata, at maghanda para sa emergency intubation kasama ang airway team. BRONCHIOLITIS (karaniwang RSV): wheezing, tachypnea, nasal flaring, at retractions sa mga sanggol; supportive care na may nasal suctioning bago magpakain, hydration, oxygen kung kailangan, at contact precautions. PERTUSSIS: paroxysmal na pag-ubo na may inspiratory whoop, droplet precautions, macrolide antibiotics. CYSTIC FIBROSIS: makapal na secretions, maalat na balat, steatorrhea, at failure to thrive; chest physiotherapy, pancreatic enzymes sa bawat kain at meryenda, high-calorie at high-protein na diet na may fat-soluble vitamins, at dagdag na asin sa mainit na panahon. FOREIGN BODY: biglaang pag-ubo o stridor sa toddler; kung hindi makaubo, makaiyak, o makapagsalita ang bata, magbigay ng paulit-ulit na cycles ng 5 back blows at 5 chest thrusts sa wala pang 1 taong gulang, o 5 back blows at 5 abdominal thrusts sa mas matatandang bata.

CROUP (laryngotracheobronchitis): viral, with a barking cough, inspiratory stridor, hoarseness and low-grade fever, worse at night; treat with a corticosteroid (oral dexamethasone) and, for stridor at rest, nebulized racemic epinephrine, keeping the child calm with the parent; cool mist or cool night air may comfort the child but does not treat croup. EPIGLOTTITIS: bacterial (classically Haemophilus influenzae type b, now rare with vaccination), with sudden high fever, the four Ds (drooling, dysphagia, dysphonia, distress), a tripod position and no cough; DO NOT examine the throat, use a tongue blade or lay the child flat; keep the child calm, upright and with the parent, and prepare for emergency intubation with the airway team present. BRONCHIOLITIS (usually RSV): wheezing, tachypnea, nasal flaring and retractions in infants; supportive care with nasal suctioning before feeds, hydration, oxygen as needed, and contact precautions. PERTUSSIS: paroxysmal coughing with an inspiratory whoop, droplet precautions, macrolide antibiotics. CYSTIC FIBROSIS: thick secretions, salty skin, steatorrhea and failure to thrive; chest physiotherapy, pancreatic enzymes with every meal and snack, high-calorie high-protein diet with fat-soluble vitamins, and added salt in hot weather. FOREIGN BODY: sudden coughing or stridor in a toddler; if the child cannot cough, cry or speak, give repeated cycles of 5 back blows and 5 chest thrusts under age 1, or 5 back blows and 5 abdominal thrusts for older children.

🏥 Sa totoong buhay

🚫 Dumating ang isang 4 na taong gulang na may lagnat, naglalaway, nakasandal pasulong, at tumatangging lumunok. Kumuha ng penlight at tongue depressor ang isang student nurse para tingnan ang lalamunan. Pinigilan siya ng charge nurse, pinanatili ang bata sa kandungan ng ina, at tinawagan ang anesthesia. Ang pagtingin sa epiglottis sa labas ng operating room ay maaaring mag-trigger ng kumpletong obstruction. Ang tamang sagot ng exam ay iyong walang ginagawa sa lalamunan.

🚫 A 4-year-old arrives febrile, drooling, leaning forward, refusing to swallow. A student nurse picks up a penlight and tongue depressor to look at the throat. The charge nurse stops her, keeps the child in the mother's lap, and calls anesthesia. Visualizing the epiglottis outside the operating room can trigger complete obstruction. The exam's correct answer is the one that does nothing to the throat.

📌 Tandaan

  • Croup: tumatahol na ubo, stridor sa gabi; dexamethasone, kasama ang racemic epinephrine para sa stridor habang nagpapahingaCroup: barking cough, stridor at night; dexamethasone, plus racemic epinephrine for stridor at rest
  • Epiglottitis: naglalaway, tripod, walang ubo: walang throat exam, maghanda para sa intubationEpiglottitis: drooling, tripod, no cough: no throat exam, prepare for intubation
  • RSV: suction bago magpakain, contact precautions; CF: enzymes sa bawat kainRSV: suction before feeds, contact precautions; CF: enzymes with every meal

📖 Mga term sa araling ito

Croup: Isang viral na impeksyon sa daanan ng hangin sa maliliit na bata na may tumatahol na ubo at stridor, ginagamot ng dexamethasone at, kung may stridor kahit nagpapahinga, nebulized epinephrine.

Epiglottitis: Isang bacterial na pamamaga ng epiglottis na may pagtulo ng laway at tripod position; huwag kailanman suriin ang lalamunan.

✅ Subukan ang sarili mo

Ang batang pinaghihinalaang may epiglottitis ay naglalaway at nakaupo nang tuwid na nakasandal pasulong. Aling aksyon ng nurse ang nangangailangan ng agarang interbensyon?A child with suspected epiglottitis is drooling and sitting upright leaning forward. Which action by a nurse requires immediate intervention?
  1. Pagsusuri sa lalamunan gamit ang tongue bladeInspecting the throat with a tongue blade
  2. Pagtawag sa airway team para pumunta sa bedsideCalling for the airway team to come to the bedside
  3. Pagpapahintulot sa bata na manatiling nakaupo nang tuwidAllowing the child to remain upright
  4. Pananatilihing nakaupo ang bata sa kandungan ng magulangKeeping the child upright in the parent's lap

Sagot: A · Pagsusuri sa lalamunan gamit ang tongue blade

Ang pagsusuri sa lalamunan ay maaaring mag-trigger ng kumpletong airway obstruction; sinisigurado ng mga bihasang staff ang airway sa kontroladong setting.

Throat examination can precipitate complete airway obstruction; the airway is secured by skilled staff in a controlled setting.

Aling interbensyon ang angkop para sa toddler na may croup at banayad na stridor sa bahay?Which intervention is appropriate for a toddler with croup and mild stridor at home?
  1. Panatilihing kalmado at nakaupo nang tuwid ang bataKeep the child calm and upright
  2. Hikayatin ang masiglang paglalaro para lumuwag ang secretionsEncourage vigorous play to loosen secretions
  3. Magbigay ng over-the-counter na cough suppressantsGive over-the-counter cough suppressants
  4. Ihiga nang patag ang bata nang nakatihayaPlace the child flat on the back

Sagot: A · Panatilihing kalmado at nakaupo nang tuwid ang bata

Ang kalmado at nakaupo nang tuwid ay nagpapaginhawa ng paghinga at nagpapababa ng pangangailangan sa oxygen, at karaniwang nagrereseta ang provider ng isang dose ng oral dexamethasone; ang stridor habang nagpapahinga ay nangangailangan ng agarang pangangalaga. Ang cool mist ay maaaring magpaginhawa ngunit hindi gamot sa croup. Hindi inirerekomenda ang cough suppressants sa maliliit na bata, pinalalala ng paghiga nang patag ang paghinga, at pinatataas ng masiglang paglalaro ang pangangailangan sa oxygen.

Calm and upright eases breathing and lowers oxygen demand, and the provider usually prescribes one dose of oral dexamethasone; stridor at rest needs urgent care. Cool mist may comfort but does not treat croup. Cough suppressants are not recommended for young children, lying flat worsens breathing, and vigorous play raises oxygen demand.

Ang batang may cystic fibrosis ay kakain na ng tanghalian. Ano ang dapat tiyakin ng nurse?A child with cystic fibrosis is about to eat lunch. What should the nurse ensure?
  1. Nakakatanggap ang bata ng pancreatic enzymes kasabay ng pagkainThe child receives pancreatic enzymes with the meal
  2. Mababa sa taba at calories ang pagkainThe meal is low in fat and calories
  3. Umiiwas ang bata sa asinThe child avoids salt
  4. Ginagawa ang chest physiotherapy kaagad pagkatapos kumainChest physiotherapy is done immediately after eating

Sagot: A · Nakakatanggap ang bata ng pancreatic enzymes kasabay ng pagkain

Ang enzymes sa bawat kain at meryenda ay nagpapahintulot sa pagsipsip ng taba at protina; ang mga diet sa CF ay mataas sa calories, taba, at asin, at ginagawa ang chest physiotherapy bago kumain.

Enzymes with every meal and snack allow fat and protein absorption; CF diets are high in calories, fat and salt, and chest physiotherapy is done before meals.

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