1 yr old presents with fever cough and Breathlessness of 3 days duration. He receivd antibiotics prior to admission
He had a furuncle 2 wk ago
He is immunized for age
He weighs 7.8kg and length of 72 cm
No h/o foreign body aspiration
He has lethargy seizures or vomiting
No failure to thrive ,recurrent respiratory infections
Rr 59/Mt,retraction lower chest,spo2 94%
Grunt+ already nasi prominent
Apex 4th ics,liver 2 cm below costal margin
What is likely possibility?
Fever cough and Breathlessness makes a respiratory infection likely
Tachypnea ,retractions andngrunt suggest along parenchymal disease
No general danger signs ,no malnutrition
What is the severity?
List 4 d/d
Younger child infancy,h/o auri,tachypnea,mild fever,chest hyperinflation,b/l wheeze,family member with viral infection 😅
children when start mouthing can have fb aspiration. Fsudden onset Breathlessness is a feature .lack of fever auri support it. Investigations like xraty are relevant with this d/d
Congenital heart disease
Left to right shunts can present with pneumonia. Failure to thrive recurrent infections. They may have abnormal pulse ,precordium or Apex with abnormal heart sounds and murmur
Pleural effusion pneumothorax
They may start with similar symptoms but progress aggressively (staph) or fail to resolve (pulmonary tb). So ask for contact with TB or big pustules or scabies or measles like 🤒illness in the child
Severely malnourished child with pneumonia could well be pneumocystis jiroveci infections
which points in history are important?
Preexisting illness gerd cerebral palsy
tobacco smoke exposure
What are the findings and justification?
lower chest retractions
alae nasi prominent
Accessory muscle like scalenes sternocleidomastoid
sub costal retractions
Dull percussion note
Chest bronchial breath sounds may be heard
harsh breath sounds
diminished breath sounds
What is the initial treatment?
Baby does not respond after 48 hours
What you do?
Check for complication like wmyema,localized effusion
What is the 2nd line 🤔?
After having ruled out complications 3rd generation cephalosporin like ceftriaxone to be started
When will you suspect staph pneumonia?
How do you classify pneumonia now?
How do you treat staph pneumonia?