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

   Nota:

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

Nota:

• -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

   Nota:

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

   Nota:

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

   Nota:

   • 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

   Nota:

   • -"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

   Nota:

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

   Nota:

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

   Nota:

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

   Nota:

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

   Nota:

   • -Dextromethorphan or guaifenesin -Local anesthetic sprays or lozenges

Nota:

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

Nota:

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

1. Pharyngitis

   Nota:

   • -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

   Nota:

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

   Nota:

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

   Nota:

   • -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

   Nota:

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

   Nota:

   • -Symptomatic treatment
7. Bronchitis

   Nota:

   • Symptomatic treatment
8. Red Flags

   Nota:

   • -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

   Nota:

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