Bronchiolitis Flashcards
What is the most common cause
Respiratory syncitial virus
What is brinchiolitis
Inflammation and infection in bronchioles
What age group does bronchiolitis occur in?
Children under 1 year, can be diagnosed in children up to 2 years rarely
most common in children under 6 months
What makes children iver 1 year more likely ot get bronchiolitis?
Ex premature babies with chronic lung disease
Why does RSV cause difficulty breathing in young children much more than adults?
AWs of infants are much smaller than those of adults so a small amount of inflammation and mucus in AW can have significant effect on infants ability to circulate air to alveoli and back out
What can hear when listen to bronchiolitis chest
Harsh breathing sounds wheezes and crackles - inflammation and mucus
Presentation of bronchiolitis?
Coryzal symptoms
Resp distress
Dyspnoea (heavy, laboured)
Tachypnoea
Poor feeding
Mild fever (under 39)
Apnoeas - episodes where child stops breathing
Wheezes and crackles on auscultation
Coryzal sympomts include
Snotty nose
Sneezing
Mucus in throat
Watery eyes
Signs of respiratory distress
Raised RR
Accessory muscle use
Intercostal and sibcostal recessions
Nasal flaring
Head bob
Tracheal tug
Cyanosis
Abnormal AW noises
Accessory muscles
Sternocleidomastoid
Abdo and intercostal muscles
What are abnormal AW noises?
Wheeze
Grunt
Stridor
What is a wheeze
Whistling sound - narrowed AWs
Expiration
What causes grunting?
Exhaling with glottis partially closed to increase positive end expiratory oresssure
What is stridor and what is it caused by?
High pitched inspiratory noise caused by obstruction of upper AW
How does bronchiolitis start?
URTI with coryzal symptoms
What is the outcome from original URTI?
50% get better spontaneously
50 % develop chest symptoms after onset of coryzal sympotms (1-2 days after)
When are symptoms of bronchiolitis worst?
3-4 days
How long do symptoms last and when do children fully recover?
Symptoms usually last 7-10 dyas
2-3 weeks full recovery
What children should automatically be admitted with bronchiolitis?
Under 3 months
Pre-existing conditions - prematuriyu, Downs, Cystic fibrosis
Clinical signs that a child should be admitted iwth bronchiolitis?
50-75% of their normal intake of milk
Clinical dehydration
RR > 70
O2 < 92%
Mod to sev resp distress
Apnoeas
Parents not confident in ability to manage or access ot medical care from home
What is mod to severe respiratory distress?
Deep recessions
Head bob
Supportive management for bronchiolitis?
Ensuring adequate intake
Saline nasal drops and nasal suctioning
Supplementary oxygen
Ventilatory support
How to ensure adequate intake in ill child
Oral NG tube
IV fluids
Depends on severity
WHy is it important to start with small frequent feeds in brinchiolitis?
Full stomach can restrict breathing
Increase feeds as tolerated
What is there little evidence for using in bronchiolitis?
Neb saline
Bronchodilators
Steorids
Antibiotics
Steps of ventilatory support?
1 - High=flow humidified oxygen
2 - Continuous positive AW pressure (CPAP)
3 - Intubation and ventilation
Do until adequate ventilation
How do you deliver high flow humidified oxygen?
Tight nasal cannula
Continious O2 with oressure
aDDS peep
What is PEEP?
Positive end expiratory pressure
How intubate and ventilate?
Inserting endotracheal tube into trachea - fully control ventialtion
What is used to monitor children on ventilatory support and in severe respiratory distress?
Capillary blood gas
Poor ventilation most helpful signs
Rising pCO2
Falling pH
What does rising pCO2 signifiy?
AWs have collapsed and cant clear waste CO2
What does falling pH signal?
CO2 build up unable to buffer
Repiratory acidosis
When is someone also in type 2 resp failure with resp acidosis?
If also hypoxic
How can bronchiolitis be prevented in high risk babies?
Monthly injection of palivzumab
How does palivizumab work>
Passive immunity - doesnt avtivate babies immune system
Circling antibodies for RSC - activates immune system to fight virus if encounters
What is Palivizumab?
Monoclonal antibody that targets RSV
Diagnostic criteria for bronchiolitis
Coryzal symptoms 1-3 dyas
Persistent cough and
Either tachypnoea or chest recession and
either wheeze or crackles on auscultation
fever, poor feeding
When consider pneumonia over bronchiolitis?
High fever over 39
Persistnetly focal crackles
When consider viral induced wheeze or early onset asthma rather than bronchiolitis in older infants and young children if they have:
Persistent wheeze without crackles or
Recurrent episodic wheeze or
personal or family history of atopy
What conditions are rare in children under 1 that are differntials for bronchiolitis and become more likely after having ahd it?
Early onset astham
Viral induced wheeze
When to suspect respiratory failure in children?
Signs of exhaustion eg listless or decreased resp effort
Recurrent apnoea
Failure to maintain adequate O2 sats depite O2 supplementation
When is it an emergency with bronchiolitis?
Apnoea
Baby or child looks seriously unwell to healthcare professional
Severe resp distress eg grunting, marked recessrion, RR >70
Central cyanosis
WHen consider regerring babies to hospital?
a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid intake (50% to 75% of usual volume, taking account of risk factors
clinical dehydration
persistent oxygen saturation of less than 92%, when breathing air.
Risk factors for severe case of bronchiolitis
chronic lung disease (including bronchopulmonary dysplasia)
haemodynamically significant congenital heart disease
age in young infants (under 3 months)
premature birth, particularly under 32 weeks
neuromuscular disorders
immunodeficiency
What persistent oxygen sats should be admitted ot hospital when under 6 weeks
92%
If over 6 weeks <90%
What persistent oxygen sats should be admitted ot hospital when under 6 weeks or with underlying health conditions
Less than 92% for children
When to discharge with bronchiolitis>
Clinically stable
Taking adequate oral fluids
Maintained O2 sats in air at following levels for 4 hours incl periods of sleep:
>90% if over 6 weeks
>92% if under 6 weeks or underlying health condition
