1 - Paeds - Resp - Chest Infections - Bronchiolitis

Question 1

% due to RSV? remainder due to?

Answer 1

80% RSV - rest = metapneumonvirus, parainfluenza, rhinovirus, adenovirus, influenza, mycoplasma pneumoniae

Question 2

% of infants admitted a year? rare after? annually what happens?

Answer 2

2-3% of infants admitted per year
rare after 1 year
annual winter epidemic

Question 3

RF’s for bronchiolitis

Answer 3

premature infants who get bronchopulmonary dysplasia

other underlying disease eg CF,

congenital heart disease

Question 4

Clinical features of bronchiolitis

-one serious compx?

Answer 4

coryzal Sx (cough, sneeze, fever) precede a dry cough and increased SOB - leads to difficulty feeding -> main reason for admission

recurrent apnoea is serious compx esp in young infants

Question 5

O/E bronchiolitis

Answer 5

sharp dry cough, tachypnoea, subcostal/IC recession, hyperinflation of chest, fine end inspiratory crackles, high pitched wheeze- exp>insp, tachycardia, cyanosis/pallor

Question 6

Ix bronchiolitis

Answer 6

PCR analysis of NPsecretions
CXR if complicated
pulse oximetry to monitor sats.
ABG/VBG if severe and monitoring for hypercapnia

Question 7

What could CXR show

Answer 7

CXR if complicated - can show hyperinflation from trapped air due to small airway obstruction, and focal atelectasis (collapse)

Question 8

MGMT bronchiolitis

Answer 8

supportive
humidified O2 by nasal cannulae
monitor for apnoea
BG/IV fluids
assisted vent via CPAP facemask or nasal
full ventilation in some

Question 9

infection control?

Answer 9

RSV infection control - hand hygiene and other measures, prevent cross infection to other infants