Bronchiolitis Flashcards
What is bronchiolitis?
Acute viral infection of the lower respiratory tract
Term most often used to refer to infection in infancy
What pathological processes characterise bronchiolitis?
Epithelial cell destruction
Cellular oedema
Airway obstruction by inflammatory debris + mucus
What is the most common cause of bronchiolitis?
Respiratory Syncytial Virus (RSV)
What are risk factors for severe bronchiolitis?
Prematurity.
Chronic lung disease.
Congenital/acquired lung disease.
Congenital heart defects (CHD)
Immunodeficiency.
FH of atopic disease.
Breastfeeding and parental avoidance of smoking are protective.
List 5 symptoms of bronchiolitis
Cough
Wheezing
Irritability, malaise, + poor feeding.
Fever <40
Rhinitis preceding other Sx
Give 3 signs of bronchiolitis
Retractions, grunting, + nasal flaring
Tachypnoea
Severe: cyanosis, lethargy
What investigations should be performed in bronchiolitis?
Pulse oximetry
Clinical dx
Can confirm with NPA
CXR (if signif resp distress to exclude pneumonia)
What is the management plan for bronchiolitis?
Supportive:
Nasal O2
NG fluids/ feeds
Consider CBG with worsening respiratory distress
Consider CPAP in children with impending respiratory failure
What drug may be used in infants with severe bronchiolitis or severe risk factors?
Ribavirin
What can be used as preventative measures for infants with congenital or acquired lung disease, CHD or immunodeficiency?
Palivizumab (RSV monoclonal antibody)
Give 4 indications in bronchiolitis for immediate admission
Apnoea
Persistent sats <90% (>6w) or <92% (<6w)
Severe respiratory distress: grunting, marked recession, RR >70
Inadequate oral fluid intake (50-75% normal)
When is oxygen indicated in bronchiolitis?
Persistent sats <90% (>6w) or <92% (<6w)
What are the criteria for discharge in an infant with bronchiolitis?
Clinically stable
Taking adequate oral fluids
Maintaining sats for 4h >90% (>6w) or >92% (<6w)
