Bronchiolitis Flashcards
What is bronchiolitis?
inflammatory obstruction of the bronchioles (small airways)
What is the most common cause of bronchiolitis?
Respiratory syncytial virus (RSV)
In which season is bronchiolitis most common?
Winter
What patient age group does bronchiolitis affect?
infants (mainly children under 1)
Why is it viruses affect infants’ bronchioles more so than adult bronchioles?
the airways of infants are very small to begin with and when there is even the smallest amount of inflammation and mucus, it has a significant effect on the infant’s ability to circulate air to the alveoli and back out
Give two sounds created by airway obstruction in brochiolitis:
1) wheeze
2) crackles on auscultation
Give 8 clinical presentations associated with bronchiolitis:
1) coryzal symptoms
2) signs of respiratory distress
3) dyspnoea
4) tachypnoea
5) poor feeding
6) mild fever (under 39 degrees C)
7) apnoea
8) wheeze and crackles on auscultation
What are coryzal symptoms?
Acute, inflammatory contagious symptoms associated with upper respiratory tract infections
Give 4 examples of coryzal symptoms:
1) runny nose
2) sneezing
3) mucous in throat
4) watery eyes
Give 7 signs of paediatric respiratory distress:
1) raised respiratory rate
2) tracheal tugging
3) abdominal airway noises
4) use of accessory muscles
5) cyanosis
6) nasal flaring
7) head bobbing
Name 3 accessory muscles that may be used in paediatric respiratory distress:
1) sternocleidomastoid
2) abdominal muscles
3) intercostal muscles
Give 3 abnormal airway noises that may be associated with paediatric respiratory distress:
1) wheeze
2) grunting
3) stridor
What is wheeze?
whistling sound typically heard on expiration caused by narrowed airways
What is grunting?
An “uh” sound during exhalation which reflects the child’s attempt to keep alveoli open caused by exhaling with the blottis partially closed to increase positive end-expiratory pressure
What is stridor?
high pitched inspiratory noise caused by obstruction of the upper airway
Describe the progression of bronchiolitis: (4)
1) it begins as an URTI with coryzal symptoms
2) half getting better spontaneously while the other half develop chest symptoms over the first 1-2 days
3) symptoms are generally worse on days 3-4
4) symptoms usually last 7 days
True or false: children who have had bronchiolitis as infants are more likely to have viral induced wheeze during childhood
True
Give 8 reasons for bronchiolitis admission:
1) aged under 3 months
2) any pre-existing conditions such as prematurity, Downs syndrome or CF
3) 50-75% or less of their normal intake of milk
4) clinical dehydration
5) respiratory rate above 70
6) oxygen saturations below 92%
7) moderate to severe respiratory distress such as recessions or head bobbing
8) apnoea
Give the 4 types of supportive treatments offered for bronchiolitis management:
1) ensuring adequate nutritional intake
2) saline nasal drops and nasal suction
3) supplementary oxygen
4) ventilatory support (if required)
Why should overfeeding be avoided in paediatric respiratory distress?
a full stomach restricts breathing movements
Where is capillary blood glucose taken from in an infant?
big toe
What antiviral is given in severe cases of bronchiolitis?
Ribavirin
what is a Paramyxovirus?
Negative strand RNA virus
What type of virus is RSV?
Paramyxovirus
How is RSV transmitted?
respiratory droplets
How is RSV infection diagnosed? (2)
1) genome detection
2) immunofluorescence of nasopharyngeal aspirates
Give two ways that passive immunity can be given to high risk infants for RSV:
monthly administration of either
1) hyperimmune globulin against RSV (IgG)
2) Palivizumbal (monoclonal antibody against RSV)
What babies are offered monthly globulins/ Palivizumbal?
high risk e.g. premature and those with congenital heart disease
When should a child be referred to the hospital?
- Apnoea
- Child looks seriously unwell to a healthcare professional
- Severe respiratory distress, for example grunting, marking chest recession, on a respiratory rate of over 70 breath/min
- Central cyanosis
- Persistent O2 saturation of less than 92% when breathing air
When should we consider referring a child to the hospital?
- a respiratory rate of over 60 breaths/minute
- difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
- clinical dehydration.
