bronchiolitis Flashcards
what is bronchiolitis?
acute viral illness that affects the lower respiratory tract
generally occurs in children under 1
seasonal infection that peaks in winter
associated with increased risk of asthma
what is the most causative agent of bronchiolitis?
respiratory syncytial virus (RSV)
what are the risk factors for bronchiolitis?
congenital heart disease
neuromuscular disorders
immunodeficiency
chronic lung disease
how to diagnose bronchiolitis?
diagnose if child has coryzal prodromal symptoms lasting 1-3 days followed by
cough, and either tachypnoea or chest recession and wheeze or crackles on chest auscultation
what are the differential diagnoses of bronchiolitis?
pneumonia- consider if high temperature or persistant focal crackles
viral-induced wheeze - without crackles, recurrent episodic wheeze, family atropy
what can young infants (those under 6 weeks) present?
just apnoea : red flag symptom and immediate referral to hospital for emergency care needed
what are the emergency considerations that require hospital admission immediately?
apnoea (observed or reported)
seriously unwell
severe respiratory distress: grunting, marked chest recessions, respiratory rate above 70bpm
central cyanosis
oxygen sat below 92% when breathing air
what is the disease progress in terms of severity of symptoms?
symptoms tend to increase in severity before resolving
what clinical scoring is used for bronchiolitis risk of admission score?
none approved by NICE
study found that bronchiolitis risk of admission score best for guiding need for hospital admission
assess 5 criteria: duration of symptoms, resp rate, heart rate, oxygen sat, age at presentation
0-5 indicates greater severity
what should you always consider when child presents with signs/ symptoms of infection?
sepsis
most symptoms of bronchiolitis also indicate infection
what should you not use to treat children with bronchiolitis?
antibiotics
hypertonic saline
nebulised adrenaline
salbutamol
montelukast
systemic or inhaled corticosteroids
what is the treatment of bronchiolitis?
supportive and no effective drug treatments
caused by virus and rate of secondary bacterial infection very low
when to give oxygen for treatment?
whilst awaiting immediate transfer to secondary care, give oxygen supplementation if persistently less than 92%
what are the risks of giving oxygen to children?
high concentration can lead to retinopathy in premature babies
what should you tell parents in primary care?
red flag symptoms: how to recognise them- reduced fluid intake, no wet nappy, apnoea or cyanosis, exhaustion, worsening work of breathing
smoking- advise not to smoke
