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Flashcards in Bronchiolitis Deck (14)
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1
Q

What is bronchiolitis?

A

Bronchiolitis is a viral lower resipiratory tract infection which affects children under the age of 12 months. After 12 months of age, there is overlap with asthma.

2
Q

Who gets bronchiolitis?

A

Affects 50% of infants in first 2 years of life. Most common LRTI in infants. Peak incidence at 6 months. Increased incidence of asthma later in life.

3
Q

What are the main pathogens which cause bronchiolitis?

A

Respiratory Syncytial Virus (>50%), Parainfluenza, Influenza, Rhinovirus, Adenovirus, M. pneumoniae (rare)

4
Q

Why is time course important to ascertain in a patient suspected/diagnosed with bronchiolitis?

A

In bronchiolitis, the time course is correlated with the severity of the symptoms. Peak severity is around day 2-3 and resolution of the illness takes 7-10 days. The cough itself can take weeks to resolve. Once the patient’s time course is ascertained, management and advice to the parents can vary based on this.

5
Q

What are the risk factors associated with severe bronchiolitis?

A
Young, especially less than 6 weeks 
Ex-premature infants
Congenital Heart Disease
Neurological Conditions
Chronic Respiratory Illness
Pulmonary HTN
6
Q

What are the clinical features on history associated with bronchiolitis?

A

Prodrome of URTI with cough and fever
Feeding difficulties, irritable
Increased work of breathing

7
Q

What are the clinical features found on examination?

A

The findings on examination vary depending on how severe the bronchiolitis is. Generally there will be:

1) Increased work of breathing
2) Widespread wheeze and creptiations
3) +/- fever
4) Decreased O2 Saturation
5) Signs of dehydration

8
Q

What are the clinical signs of increased work of breathing?

A
Tachypnoea
Tracheal Tug
Subcostal Recession
Intercostal Recession
Abdominal Breathing
Nasal Flare
Head Bobbing
Need for Oxygenation
9
Q

What are the three categories of severity of bronchiolitis? What is different between the categories?

A

There is mild, moderate and severe bronchiolitis. The parameters which are observed are behaviour, respiratory rate, accessory muscle use, feeding, O2 and apnoeic episodes.
Behaviour: normal -> some/intermittent irritability -> increasing irritability/lethargy, fatigue
Respiratory Rate: normal -> increased respiratory rate, tracheal tug, nasal flaring -> marked increase or decrease in RR, tracheal tub, nasal flaring
Accessory Muscle Use: None -> moderate chest wall retraction -> marked chest wall retraction
Feeding: Normal -> difficulty/reduced feeing -> reluctant/unable to feed
Oxygen: SaO2>93% -> SaO2 90-93% -> SaO2 Brief Apnoeas -> Frequent/Prolonged Apnoeas

10
Q

Do you need investigations for patient with suspected bronchiolitis? If so, what are they?

A

No investigations are required. If diagnostic uncertainty (?pneumonia or ?CCF) then CXR may be required. CXR will show hyperinflation, peribronchial thickening, and often patchy areas of consolidation and collapse.

11
Q

When do you admit a patient with bronchiolitis?

A

Hypoxia: O2 saturation less than 92% therefore needing O2
Increased WOB consistent with Severe Bronchiolitis
Significantly decreased feeding
If increased risk factors are present such as: young infant (less than 6 months) ), premature baby, Hx of chronic lung infections, neurological conditions, haemodynamically significant cardiac disease.

12
Q

What is the management of each degree of severity of bronchiolitis?

A

Mild – Managed at home, advice re: expected course of illness
Moderate – Managed in hospital, Administer O2 to get SaO2>92%, consider requirement for maintenance fluid, 1-2hrly observations
Severe – Cardiorespiratory monitoring, supplemental O2 + fluids, child may need CPAP/ventilation so transfer to HDU/ICU must be considered.

13
Q

Do you use bronchodilators in bronchiolitis?

A

Nope. It has not been shown to alter the course of the illness.

14
Q

What are the discharge requirements for a patient being treated for bronchiolitis?

A
  1. Maintaining adequate oxygenation

2. Maintaining adequate oral intake