Bronchiolitis - GM Flashcards
(42 cards)
what is bronchiolitis
lower respiratory tract infection in infants less than 12 months
due to inflammation of the bronchioles and build-up of mucous
common respiratory condition
peak age of incidence of bronchiolitis
a third of infants will develop it before the age of 1
peak incidence around 3-6 months
incidence linked with the winter period
less diagnostic certainty in the 12-24 month age range
aetiology of bronchiolitis
usually caused by viral infection
80% caused by RSV
less common causes include: parainfluenza virus, rhinovirus, adenovirus, influenza, human metapneumovirus
risk factors for admission to hospital with severe episode of bronchiolitis include
chronic lung disease
congenital heart disease
prematurity at less than 37 weeks gestation
<10 weeks old at presentation
postnatal exposure to cigarette smoke
breast-fed for less than 2 months
downs syndrome
cystic fibrosis
neuromuscular disease
indigenous ethnicity
typical symptoms of bronchiolitis include
persistent cough
wheeze
shortness of breath
apneoa - in infants younger than 6 weeks of age, also typically seen with RSV
poor feeding - young children are obligate nasal breathers, making it difficult to feed and breathe at the same time during bronchiolitis
dehydration - reduced urine output or fewer wet nappies
typical course of illness of bronchiolitis
a prodrome of upper respiratory tract features - fever, runny nose, cold
symptoms typically worsen during 2nd or 3rd night of illness
resolution over 7-10 days
typical clinical findings of bronchiolitis
respiratory status:
- bilateral polyphonic expiratory wheeze
- use of accessory muscles
- hypoxia
- tachypnoea
- cyanosis
hydration status:
- dry mucous membranes
- sunken fontanelle in young babies
tachycardia
low-grade fever <39°
irritability
how would you know if it was actually penumonia
fever >39°
focal crackles
how would you know if it was actually viral induced wheeze
persistent wheeze without crackles
recurrent wheeze associated with a viral illness
personal or family history of atopy
>1-year-old
responsive to salbutamol treatment
how would you know if it was actually early-onset asthma
persistent wheeze without crackles
recurrent wheeze associated with triggers
personal or family history of atopy
>1 year old
responsive to salbutamol treatment
how would you know if it was actually whooping cough
coryza
characteristic hacking cough followed by an inpiratory whoop
unvaccinated
how would you know if it was actually gastro-oesophageal reflux
chronic cough
poor weight gain
how would you know if it was actually foreign body aspiration
may have history of choking
monophonic wheeze
how would you know if it waas atcually chronic heart disease or failure
cyanosis
shortness of breath
hepatomegaly
murmurs
children can be diagnosed with bronchiolitis if
clinical diagnosis
children are diagnosed if they present with coryzal symptoms lasting up to 3 days, followed by
- persistant cough and
- tachypnoea or chest recession and
- wheeze or crackles on chest auscultation
what sort of investigations should be ordered
investigations to not influence the treatment of bronchiolitis
pulse oximetry: children should be admitted of oxygen saturation is <90%
criteria for admission to secondary care
bronchiolitis is self-limiting
not all children with bronchiolitis will require admission to hospital
criteria for admission to secondary care:
- apnoea
- reduced oxygen saturation <90%
reduced oral intake, 50-75% of normal
- persistent respiratory distress:significant chest recessions, grunting
- presence of risk factors for severe disease
- difficult social factors: living far from hospital, lack of parental confidence
are bronchodilators effective for bronchiolitis
no
bronchodilators are not effectoive because the respiratory tract narrowing is due to increased secretions, not bronchoconstriction
are antibiotics effective for bronchiolitis
no - due to viral cause
complications of bronchiolitis
clinical dehydration
syndrome of inappropriate antidiuretic hormone (SIADH) and subsequent hyponatraemia
apnoea and respiratory failure requiring intubation and ventilation
examination of child with bronchiolitis
assess respiratory status including resp rate, oxygen saturations, and work of breathing
child may look pale and unwell
decreased level of consciousness indicates exhaustion and impending risk of respiratory arrest
cyanosis is a late sign and indicates severe disease
fever may be present
signs of dehydration
bronchiolitis on chest auscultation
bilateral widespread wheeze and/or crackles
areas of decreased air entry (due to atelectasis from mucous plugging)
clinical signs of dehydration
sunken fontanelle, slow cap refill, dry mucous membranes, also: sunken eyes and skin turgor
signs of increased work of breathing
nasal flaring, head bobbing, tracheal tug, accessory muscle use and grunting
