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Childs Health > Bronchiolitis > Flashcards

Bronchiolitis Flashcards

1
Q

What is the most common cause

A

Respiratory syncitial virus

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2
Q

What is brinchiolitis

A

Inflammation and infection in bronchioles

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3
Q

What age group does bronchiolitis occur in?

A

Children under 1 year, can be diagnosed in children up to 2 years rarely
most common in children under 6 months

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4
Q

What makes children iver 1 year more likely ot get bronchiolitis?

A

Ex premature babies with chronic lung disease

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5
Q

Why does RSV cause difficulty breathing in young children much more than adults?

A

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

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6
Q

What can hear when listen to bronchiolitis chest

A

Harsh breathing sounds wheezes and crackles - inflammation and mucus

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7
Q

Presentation of bronchiolitis?

A

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

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8
Q

Coryzal sympomts include

A

Snotty nose
Sneezing
Mucus in throat
Watery eyes

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9
Q

Signs of respiratory distress

A

Raised RR
Accessory muscle use
Intercostal and sibcostal recessions
Nasal flaring
Head bob
Tracheal tug
Cyanosis
Abnormal AW noises

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10
Q

Accessory muscles

A

Sternocleidomastoid
Abdo and intercostal muscles

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11
Q

What are abnormal AW noises?

A

Wheeze
Grunt
Stridor

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12
Q

What is a wheeze

A

Whistling sound - narrowed AWs
Expiration

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13
Q

What causes grunting?

A

Exhaling with glottis partially closed to increase positive end expiratory oresssure

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14
Q

What is stridor and what is it caused by?

A

High pitched inspiratory noise caused by obstruction of upper AW

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15
Q

How does bronchiolitis start?

A

URTI with coryzal symptoms

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16
Q

What is the outcome from original URTI?

A

50% get better spontaneously
50 % develop chest symptoms after onset of coryzal sympotms (1-2 days after)

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17
Q

When are symptoms of bronchiolitis worst?

A

3-4 days

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18
Q

How long do symptoms last and when do children fully recover?

A

Symptoms usually last 7-10 dyas
2-3 weeks full recovery

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19
Q

What children should automatically be admitted with bronchiolitis?

A

Under 3 months
Pre-existing conditions - prematuriyu, Downs, Cystic fibrosis

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20
Q

Clinical signs that a child should be admitted iwth bronchiolitis?

A

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

21
Q

What is mod to severe respiratory distress?

A

Deep recessions
Head bob

22
Q

Supportive management for bronchiolitis?

A

Ensuring adequate intake
Saline nasal drops and nasal suctioning
Supplementary oxygen
Ventilatory support

23
Q

How to ensure adequate intake in ill child

A

Oral NG tube
IV fluids
Depends on severity

24
Q

WHy is it important to start with small frequent feeds in brinchiolitis?

A

Full stomach can restrict breathing
Increase feeds as tolerated

25
Q

What is there little evidence for using in bronchiolitis?

A

Neb saline
Bronchodilators
Steorids
Antibiotics

26
Q

Steps of ventilatory support?

A

1 - High=flow humidified oxygen
2 - Continuous positive AW pressure (CPAP)
3 - Intubation and ventilation
Do until adequate ventilation

27
Q

How do you deliver high flow humidified oxygen?

A

Tight nasal cannula
Continious O2 with oressure
aDDS peep

28
Q

What is PEEP?

A

Positive end expiratory pressure

29
Q

How intubate and ventilate?

A

Inserting endotracheal tube into trachea - fully control ventialtion

30
Q

What is used to monitor children on ventilatory support and in severe respiratory distress?

A

Capillary blood gas

31
Q

Poor ventilation most helpful signs

A

Rising pCO2
Falling pH

32
Q

What does rising pCO2 signifiy?

A

AWs have collapsed and cant clear waste CO2

33
Q

What does falling pH signal?

A

CO2 build up unable to buffer
Repiratory acidosis

34
Q

When is someone also in type 2 resp failure with resp acidosis?

A

If also hypoxic

35
Q

How can bronchiolitis be prevented in high risk babies?

A

Monthly injection of palivzumab

36
Q

How does palivizumab work>

A

Passive immunity - doesnt avtivate babies immune system
Circling antibodies for RSC - activates immune system to fight virus if encounters

37
Q

What is Palivizumab?

A

Monoclonal antibody that targets RSV

38
Q

Diagnostic criteria for bronchiolitis

A

Coryzal symptoms 1-3 dyas
Persistent cough and
Either tachypnoea or chest recession and
either wheeze or crackles on auscultation

fever, poor feeding

39
Q

When consider pneumonia over bronchiolitis?

A

High fever over 39
Persistnetly focal crackles

40
Q

When consider viral induced wheeze or early onset asthma rather than bronchiolitis in older infants and young children if they have:

A

Persistent wheeze without crackles or
Recurrent episodic wheeze or
personal or family history of atopy

41
Q

What conditions are rare in children under 1 that are differntials for bronchiolitis and become more likely after having ahd it?

A

Early onset astham
Viral induced wheeze

42
Q

When to suspect respiratory failure in children?

A

Signs of exhaustion eg listless or decreased resp effort
Recurrent apnoea
Failure to maintain adequate O2 sats depite O2 supplementation

43
Q

When is it an emergency with bronchiolitis?

A

Apnoea
Baby or child looks seriously unwell to healthcare professional
Severe resp distress eg grunting, marked recessrion, RR >70
Central cyanosis

44
Q

WHen consider regerring babies to hospital?

A

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.

45
Q

Risk factors for severe case of bronchiolitis

A

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

46
Q

What persistent oxygen sats should be admitted ot hospital when under 6 weeks

A

92%
If over 6 weeks <90%

47
Q

What persistent oxygen sats should be admitted ot hospital when under 6 weeks or with underlying health conditions

A

Less than 92% for children

48
Q

When to discharge with bronchiolitis>

A

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

Childs Health (82 decks)

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