2.1 Bronchiolitis Flashcards
What are the signs of respiratory distress in kids?
- Raised respiratory rate
- Use of accessory muscles (sternocleidomastoid, abdominal and intercostal muscles)
- Intercostal and subcostal recessions
- Nasal flaring
- Head bobbing
- Tracheal tugging
- Cyanosis (due to low oxygen saturation)
- Abnormal airway noises
What causes these abnormal airway noises: wheezing, grunting, stridor?
- Wheezing is a whistling sound caused by narrowed airways, typically heard during expiration
- Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure
- Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup
Who gets bronchiolitis?
Presentation?
<1y olds in winter (can be in ex-prems up to 2yrs old)
- Coryzal symptoms. Typical Sx of a viral URTI: running or snotty nose, sneezing, mucus in throat and watery eyes.
- Signs of respiratory distress
- Dyspnoea (heavy laboured breathing)
- Tachypnoea (fast breathing)
- Poor feeding
- Mild fever (under 39ºC)
- Apnoeas are episodes where the child stops breathing
- Wheeze and crackles on auscultation
What causes / what is happening in bronchiolitis?
Commonly RSV.
Inflammation and mucous narrows the small bronchioles in an infant more than they would in wider adult ones.
–> harsh breath sounds –> wheeze and crackles
Typical course of RSV
URTI Sx with coryza then maybe bronchiolitis:
- Half get better spontaneously.
- Half get chest Sx that are worse on day 3 or 4.
- Generally Sx for 7-0 days and fully recover in 2-3 week.
- More likely to get viral induced wheeze in childhood.
When do you admit bronchiolitis?
(Most are managed at home)
Admission reasons:
- Aged under 3 months or any pre-existing condition such as prematurity, Downs or CF
- 50 – 75% or less of their normal intake of milk
- Clinical dehydration
- Respiratory rate above 70
- Oxygen saturations below 92%
- Moderate to severe respiratory distress, such as deep recessions or head bobbing
- Apnoeas
- Parents not confident in their ability to manage at home or difficulty accessing medical help from home
What is the management of bronchiolitis?
FLUID: adequate oral, NG or IV. Dont overfeed.
SALINE NASAL drops or suctioning can help esp before feeds.
OXYGEN: is sats remain below 92%
VENTILATION if required:
- high flow humid O2 (Airvo or optiflow) through tight nasal cannula with peep
- CPAP using sealed nasal cannula, higher and more controlled pressures
- Intubation and ventilation; endotracheal tube
Asses ventilation using capillary blood gas. (rising pCO2 or falling pH –> type 2 resp failure)
What protection can be given to high risk babies to avoid bronchiolitis?
PALIVIZUMAB
Mab against RSV which then activates the immune system
(passive protection, not a vaccine obvs)
Given to: ex-prems and congenital heart disease.
