Bronchiolitis Flashcards Preview

Pediatrics > Bronchiolitis > Flashcards

Flashcards in Bronchiolitis Deck (16):
1

Definition

Generalised LRTI with widespread wheeze

2

Epidemiology

Most common LRTI infants
50% in first 2 years
+Winter
+incidence of asthma later in life

3

Etiology

Viral most commonly
RSV (which can also cause lobar pneumonia)

4

Clinical features

Cough
Wheeze
Tachypnea
Apnea

Food feeding
Fever
Respiratory distress

Crackles + wheeze

5

Diagnosis

Age

6

Assessment of severity: severe, moderate, mild

Severe:
-++WOB
-Fi)2 >0.5 to keep O2 >92%
-poor feeding
-apnoiec episodes

Moderate:
-Some +WOB
- reduced fluid
-SpO2

Mild:
Normal behaviour, TT, no respiratory accessory, normal feeding, no oxygen requirement

7

Management

Diagnosis
Assess severity
1. Severe-->Oxygen, keep 02% >92%. Fluids IV at 75% maintenance. Monitor in ICU. Consider nasal/ETT CPAP or ventilation
2. Moderate-->
-Admit, single room
-Minimal handling
-Observe closely 1-2 hourly
-Give O2 to keep >92%
-Monitor fluid, use IV/NG as required up to 75% maintenance as risk of SIADH
-D/C when appropriate
3. Mild-->
-Home treatment
-Advise about expected course, return if any problems
-Patient information
-Monitor fluids->small feeds frequently (maybe hourly)
-Advise medical review if early in disease
-Avoid respiratory "toxins"
-Avoid visiting other babies
-Panadol for discomfort
-Plan early review particularly in those with risk factors

Ensure breast feeding support

8

When to discharge

Feeding +
Normal/near normal WOB
No requirements for supplemental oxygen

9

History

Age
Contact with LRTI
Coryza/URTI
Cough
Wheeze/crackles
Decreased feeding->feeding and urine output
Apnea, colour change
Risk factors
Duration->get worse before better

FH atopy, eczema, asthma->tends to be more common, risk of developing asthma
Exposure to smoking

10

Peak severity, resolution, cough persistence

Day 2, 3, 5
Resolution 7-10 days
Cough may persist for weeks 4

11

Risk of severe disease

Age

12

Examination

General inspection
Vitals
+/- coryza
+WOB
Signs of dehydration
Apnoeic episodes
Wheeze, crepitations, AE->diffuse crackles

13

Use of bronchodilators

May be trialled in older, or family history
Usually not responsive

14

How to ensure minimal handling

Cluster observations, investigations, nappy change and feeds

15

If pale, grunting what should you consider

Pnemonia and ?CXR

16

Supportive therapy

Fluids
Paracetamol
Humidified oxygen
Head elevation
Suctioning of secretions
Minimal handling
Regular monitoring

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