Upper Respiratory Infections (URIs)

1. Rhinovirus (60% of cases)
   1. R0=6
   2. Case fatality = 0
2. Many other organisms
3. Transmission via direct contact

   Annotations:

   • -Droplet spread -Aerosolized via cough/sneeze -Contact with tissues -Contact with fomites

Annotations:

• -Younger populations -Large group contact -Immunocompromised, stress, malnutrition -Smoking, second-hand smoke -Anatomic changes, facial dysmorphism, upper airway trauma, nasal polyposis

1. Non-specific Presentation

   Annotations:

   • Cough, sneezing, swollen nares (congestion), increase in mucus production (rhinorrhea)
2. Presentation in Children

   Annotations:

   • May present with fever, wheezing, loss of appetite, fussiness, drowsiness, dehydration
3. Vital Signs

   Annotations:

   • High temp, high HR, high RR, either high or low BP

1. Dx usually based on signs, symptoms, PE findings
2. Test only for specific organisms ONLY ordered when therapy depends on result

1. General Treatment

   Annotations:

   • -"There is no cure for the common cold" -Reassurance -Education -Instructions for symptomatic home treatment -Antibiotics are CONTRAINDICATED for the common cold
2. Treatment for Congestion and Rhinorrhea

   Annotations:

   • -Saline drops or spray -Humidification -OTC nasal decongestion or oral product -Bedtime 1st gen antihistamine
3. Treatment for Aches

   Annotations:

   • -Warm showers or baths (reduces aching) -OTC analgesic prn for pain
4. Treatment for Fever

   Annotations:

   • -NSAID or antipyretic  -No aspirin in children (REYES syndrome)
5. Treatment for Sore Throat

   Annotations:

   • -Saline gargles every 4 hours -Local anesthetic sprays or lozenges (small tablet)
6. Treatment for Cough

   Annotations:

   • -Dextromethorphan or guaifenesin -Local anesthetic sprays or lozenges

Annotations:

• Avoid close contacts, avoid touching mucous membranes, cover your nose while sneezing, dispose of dirty tissues, wash your hands, social distancing 

Annotations:

• Initial infection may spread to adjacent structures -Sinusitis, otitis media, epiglottitis, laryngitis, tracheitis, bronchitis, pneumonia

1. Pharyngitis

   Annotations:

   • -Throat culture for unimproved pts. -Use Centor score for pharyngitis/tonsilitis (absence of cough, anterior cervical lymphadenopathy, fever, tonsillar erythema or exudates, age)
2. Rhinosinusitis

   Annotations:

   • -Symptomatic management -Radiology if complications are suspected (meningitis, orbital cellulitis, intracranial abscess) -Amoxicillin for severe or uncomplicated rhinosinusitis
3. Croup (Laryngotracheobronchitis)

   Annotations:

   • -Steeple sign on CXR, inspiratory stridor -Corticosteroids -Nebulized epinephrine +/- cool mist nebulized saline
4. Epiglottitis

   Annotations:

   • -Thumb sign on lateral CXR -Don't examine the throat  -Position for comfort -Have ETT/trach tube available if needed -Cool mist humidification -Oxygen -IV fluids -Antibiotics
5. Laryngitis

   Annotations:

   • -Inhale humidified air to help clear secretions and exudate -Rest voice
6. Bronchiolitis and RSV

   Annotations:

   • -Symptomatic treatment
7. Bronchitis

   Annotations:

   • Symptomatic treatment
8. Red Flags

   Annotations:

   • -Temp >100.4 F -Dyspnea or chest pain -Underlying chronic cardiopulmonary disease -Age <9 months or frail/elderly -Worsening/unresponsive to OTC medications -New symptoms suggesting complications

1. Typically mild and self-limited
2. Immunocompromised

   Annotations:

   • Immunocompromised, elderly, and infants are more likely to have lethal complications