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Respiratory Conditions

It’s 2am, you wake to hear your 5 year old with a horrible, barking cough and notice a strange high pitched whistling sound every time they take a breath in. What is going on?
Or how about this one…
Everyone in the house has been unwell for the last few days. Your 3 year old has a fever, cough and a runny nose. But they’re still climbing all over the couch, trying to feed the cat to the dog and won’t keep their pants on. Do they need to go to the doctor?

Welcome to another blog folks, and if you haven’t been hit yet, ‘tis the season for respiratory illnesses!
So following on from the excellent demonstration by Alicia recently of How to administer an Asthma puffer (Salbutamol otherwise known as Ventolin or Asmol) through a spacer, we’ll have a look at some of the common respiratory complaints that may affect both adult and child alike, along with the first aid management for them.

Common Cold

runny noseTo begin with, let’s take a look at the common cold. This fun infection can be caused by any number of viruses, including rhinoviruses, adenoviruses, coronaviruses, and the list goes on. If your kiddo’s go to a petri dish sorry, childcare or school, they’re bound to come home with it at some stage as it is so very common and easily transmitted. Since kids just love to share, siblings and parents or caregivers are also bound to experience some of the more commonly associated symptoms such as a cough, sore throat, sneezing, runny nose and maybe even a fever. Things become a bit more sinister if the patient develops any signs of respiratory distress along with these common symptoms.

What to watch out for….

– Extreme lethargy
– Fever doesn’t go away after 48 hours (despite being managed with Paracetamol or Ibuprofen)
– They don’t want to drink (6 hours or more is not great),
– Less than half the number of wet nappies
– A non-blanching rash develops. Blanching is when you press on the rash and it momentarily turns white or disappears because of the pressure, but if it is non-blanching then the colour will remain unchanged. This could potentially indicate a very serious illness – meningitis.
(A cool trick is to get a glass you can see through and roll it over the rash to see if it momentarily goes away, since you cannot see the skin’s colour change if your finger is in the way).

If you notice any of these things happening, best to get off to the doctor or if you’re really concerned, call an ambulance.
Otherwise, if none of the ‘red flags’ mentioned above are occurring, brace yourself for a deluge of Peppa Pig or Bluey, icy poles and Panadol/Nurofen. These ones can mostly be managed at home with rest, basic pain relief and plenty of fluids.

TIP OF THE DAY Ditch the cough medicines.

Evidence suggests that over the counter cough medicine does not work, particularly in children under the age of six. What has been shown to relieve symptoms of a dry cough is 1-2 spoonful’s of honey before bed. Bearing in mind that you cannot give honey to children under the age of 12 months (as there is a risk of botulism).

Influenza

Influenza is another virus that kicks around in higher numbers this time of the year. Not so much because of the change in temperature but because people tend to remain indoors when the weather is wet and dreary, meaning viruses are more easily spread amongst greater numbers of people in close proximity breathing all over each other.

The flu has very similar signs and symptoms in comparison to the common cold, only this time we sprinkle in some body aches and chills along with shaking despite not being cold (aka rigors, associated with fever) and that general feeling of ‘being hit by a bus’. Again, it’s a virus. So be sure to manage the symptoms accordingly with fluids, rest and simple pain relief.
Contact an ambulance if breathing becomes problematic as with the cold, but generally, this one can be managed at home.

But why can’t I just take antibiotics???

This is a very common question when managing patients who have the cold or flu.
Simple answer is, they just won’t work and you’ll be wasting your money. Antibiotics work on bacterial infections. The flu/ cold is a virus and, without going into a very complicated explanation, antibiotics target a completely different mechanism to what viruses have. There are antiviral (sometimes called retroviral) medications that may be prescribed to higher risk folk. But for most, prevention in the form of vaccination is the best for viruses and if you get one, simply stick to those basic, supportive cares we mentioned before.

RSV

Respiratory Syncytial Virus (RSV), is another very common condition that does the rounds in winter. Displaying exactly the same signs and symptoms as the common cold, the RSV virus is a bit nastier as it can cause pneumonia or bronchiolitis and is a common trigger for asthma. Anyone can get RSV and like most viruses, unless you’re swabbed for it at a GP or hospital, chances are you have had it (or have got it now) and don’t know. The reality is, it doesn’t really matter as the management is the same whether you know what it is or not. Supportive cares with reassurance, fluids, simple pain relief and rest. As with all viral infections, a GP, ambulance or hospital visit is warranted for breathing difficulties, going blue, breathing fast, or if you, as a parent, feel that something ‘isn’t quite right’.

Where treatment does differ, is if we have a known bacterial infection – in which case we can target that infection with specific types of antibiotics.

Bronchiolitis

Chest infections that lead to something known as bronchiolitis can be quite serious. Bronchiolitis is caused by an inflammation of the bronchioles in the lungs, basically the pipes lower down in the lungs. It is characterised by the following:

– Fast breathing – possibly noisy/wheezy
– Irritable behaviour
– Fever
– Trouble eating/ drinking
– Laboured breathing – where the skin between the ribs or under the neck appears to be sucking in, nasal flaring and little babies may bob their heads.
Bronchiolitis is one that needs some heavy-duty management in hospital. Usually occurring in kids under six months old, you can find it up to a year old. Management can include steroids, adrenaline, oxygen and fluids.
From a first aid perspective though, call an ambulance if lips are turning blue or it looks like they’re struggling to breathe.

Again, viral infection = no antibiotics.

Croup

Croup is another common condition in younger kids up to about the age of 6. This is the middle of the night wake up with a ‘seal bark’ cough, a hoarse voice and stridor (the high-pitched whistling sound when the little tacker is breathing in). Differing from bronchiolitis and asthma, this is an upper airway infection which leads to swelling of the trachea and larynx (wind-pipe and voice-box). Again, this one is caused by a viral infection and the management is supportive only. For mild cases of croup and if the family have a history of it, croup can be managed at home with a lot of reassurance, simple pain relief and keeping them calm (agitation causes breathing to become harder). If it’s your first time, or the child is showing signs of distress (including blue lips, skin sucking in on the neck, persistent stridor and/or drooling/unable to swallow), an ambulance trip to hospital is warranted. Paramedics and/or doctors will administer steroids and possibly adrenaline in a nebuliser, with the aim of reducing that upper airway swelling. Croup generally lasts only about 4 days, with the worst symptoms at day 2 or 3.
A lingering cough can be there for a couple of weeks though.

These are a few of a whole host of respiratory conditions out there, but are the more common ones that will be encountered as a first aider/ parent. Definitely watch the video posted a few weeks ago to refresh yourself on what to do when someone is having an Asthma attack.
As always, get yourself on to a first aid course if you haven’t done one already and if it’s been a while, get it updated as some things do change. And by all means, if you have some spare time, read up more on these conditions, there are great resources out there, particularly fact sheets from children’s hospitals. Stay safe folks and thanks for reading.

Craig Middleton
Craig Middleton

Registered Paramedic - Brisbane, QLD