[2] Bronchiolitis Flashcards
What is bronchiolitis?
A common LRTI that affects babies and young children under 2 years
How sever are most cases?
Mild
How long do mild cases last?
Clear up within 2-3 weeks
Do mild cases require treatment?
No
What is needed in sever cases?
Hospitalisation
What is the causative pathogen in 80% of cases?
RSV
What is RSV?
Respiratory Syncytial Virus
What other organisms can cause bronchiolitis?
- Parainflueza virus
- Rhinovirus
- Adenovirus
- Influenza
- Human metapneumovirus
What are the risk factors for developing bronchiolitis?
- Premature infants who develop bronchopulmonary dysplasia
- Underlying lung disease e.g. CF
- Congenital heart disease
What are the initial symptoms in bronchiolitis?
Coryzal symptoms
What symptoms follow the initial coryzal symptoms?
Dry cough and increasing wheezy breathlessness
What is the main reason for hospital admission in bronchiolitis?
Feeding difficulty due to increasing dyspnoea
What are the signs of bronchiolitis?
- High-pitched wheeze
- Tachypnoea
- Tachycardia
- Subcostal and intercostal recessions
- Hyperinflation of the chest
- Fine end-inspiratory crackles
What is the only routine recommended investigation in bronchiolitis?
Pulse oximetry
When may a CXR and blood gases be required in bronchiolitis?
When respiratory failure is suspected
What are the differentials for bronchiolitis?
- Asthma
- Pneumonia
- Heart failure
- Allergic reaction
- Cystic fibrosis
What are the indications for hospital admission?
- Apnoea
- Persistent SpO2 <90% on air
- Inadequate oral fluid intake
- Severe respiratory distress
What constitutes inadequate oral intake?
50-75% normal volume
What may indicate respiratory distress?
- Grunting
- Marked chest recession
- RR > 70
What does management involve?
Supportive including:
- Humdified O2 via nasal cannulae
- Fluids
- Assisted ventilation - only in some cases
How can fluids be given?
Via NG or IV
What are the forms of assisted ventilation?
- Non-invasive CPAP
- Mechanical ventilation
What ward management requirements are essential in managing patients with bronchiolitis?
Good infection prevention techniques
Why are good infection prevention techniques required in bronchiolitis management?
RSV is highly infective
What infection prevention techniques can be employed?
- Good hand hygiene
- Cohort nursing
- Gowns and gloves
What prophylactic treatment can be given in children at high risk to reduce the number of hospital admissions?
IM Palivizumab
What is Palivizumab?
A monoclonal antibody to RSV
Why is Palivizumab not given to treat RSV?
It has a high number needed to treat and requires multiple IM injections
What are the potential complications of bronchiolitis?
- Respiratory distress
- Dehydration
- Recurrent apnoea
- Permanent damage to airways
