Bronchiolitis

Question 1

Causes

Answer 1

Respiratory syncytial virus 75-80% cases

Other causes: mycoplasma, adenovirus

Question 2

More serious cases

Answer 2

Bronchopulmonary dysplasia (premature)

Congenital heart disease

Cystic fibrosis

Question 3

Features

Answer 3

Coryzal symptoms including mild fever first

Dry cough

Increasing breathlessness

Wheezing, fine inspiratory crackles (not always present)

Feeding difficulties are often reason for hospital admission

Question 4

Ambulance referral if

Answer 4

Apnoea

Child looks seriously unwell to healthcare professional

Severe respiratory distress

Central cyanosis

Persistent O2 sats <92% on air

Question 5

Severe respiratory distress

Answer 5

Grunting

Marked chest recession

RR >70

Nasal flaring

Head bobbing

Tracheal tugging

Question 6

Consider referral to hospital if

Answer 6

RR >60

Difficulty with breastfeeding in inadequate oral fluid intake

Clinical dehydration

Question 7

Management

Answer 7

Largely supportive

Humidified O2 if sats <92%

NG if not feeding

Suction for excessive upper airway secretions