Bronchitis

Question 1

Essentials of Diagnosis:

• Cough associated with midline burning chest pain, fever, and dyspnea.

Answer 1

Bronchitis

Question 2

General Considerations:

• Very similar to Pneumonia
• The primary clinical difference between from pneumonia is associated with presence of an infiltrate on the chest X-ray in the case of pneumonia.
• In a patient without underlying lung disease should not cause hypoxia
• *Chronic is defined by excessive production of mucous and daily productive cough for 3 months or more in 2 consecutive years.
• Outdoor air pollution, airway infection, familial factors, and allergy have been implicated in chronic bronchitis.

Answer 2

Bronchitis

Question 3

Physical Findings:

• Diagnosis is based primarily on history and physical.
• Patients complain of cough, fever, and constitutional symptoms.
• Cough is initially dry but can become productive.
• Often associated with midline chest pain or burning.
• Hemoptysis, wheezing, and rales may be present.
• Rhonchi that clears with coughing is a characteristic finding.
• The presence of rales is more characteristic of pneumonic consolidation or other condition involving the pulmonary parenchyma.
• Cigarette smoking is a cause or contributing factor in many cases.

Answer 3

Bronchitis

Question 4

Lab/Imaging Findings:

• X-ray will usually show no evidence of infiltrate
• Not indicated without dyspnea, hypoxia, or significant comorbidity

Answer 4

Bronchitis

Question 5

Treatment:

Acute rarely needs aggressive management.
* Acetaminophen
* NSAIDS - Nonsteroidal Anti-Inflammatory Drug
~ Ibuprofen
~ Naproxen
~ Meloxicam
~ Celecoxib
* Benzonatate 100-200mg TID - Cough suppressants/Antitussives
* SABA
Albuterol 90 mcg MDI 2 - 4 puffs q4-6h prn
Levalbuterol
* Expectorants
Guaifenesin 100-400 mg PO q4 hours
* Dextromethorphan

Antibiotics are not recommended unless the course is prolonged, or the patient has significant underlying comorbidities.

Primary cause is viral etiology.

Answer 5

Bronchitis

Question 6

Disposition:

• Hypoxic patients and those with significant underlying cardiopulmonary disease may require close monitoring.
• Modified duty. 1-2 days SIQ or light duty as needed.
• Retain on board.
• Complications
• Chronic presentation
• Significant underlying comorbidity.

Answer 6

Bronchitis

Question 7

Give Doxy or zpacks for those that are allergic

Answer 7

to penicillin

Question 8

100.4 Rule

Answer 8

72 hrs to call off
Fever