Bronchiolitis Flashcards
Define Bronchiolitis
infection/inflammation of the small airways in the lungs
Bronchiolitis most common causative virus
Respiratory Syncytial Virus (RSV)
RSV bronchiolitis risk factors
- infant under 6months
- pre-termed children
- long-term heart/lung conditions
- Expose to smoke
At what age is RSV most common in children
infant under 6 months
bronchiolitis presentations
- Coryzal symptoms (runny nose, sneezing, watery eyes)
- Low-grade fever (under 39ºC)
- Nasal congestion
- Feeding difficulty
- Tachypnoea
- Apnoeas (episodes where the child stops breathing)
List 3 abnormal airway noises
- Wheeze
- Grunting
- Stridor
what causes a wheeze
Narrowed airways usually heard during expiration
what causes grunting
Exhaling with partially closed glottis - to increase positive end-expiration pressure to restrict outflow of air from the lungs to prevent the small airways from collapsing
what causes stridor
Obstruction to the upper airway: High pitched inspiratory noise
Bronchiolitis Timeline
- Coryzal Sx
- 1-2D: Chest Sx
- 3-4D: Sx at worst
- Sx last for 7-10D
- 2-3 wks fully recover
Bronchiolitis stat hosp admission criteria
- apnoea
- severe respiratory distress (grunting, intercostal or subcostal recession, tracheal tugging)
- RR >60
- central cyanosis
- O2 sat. <92%
- Age under 3 months
- Pre-mature infant (<37 weeks)
- Pre-existing conditions
- intake 50-70% of normal feed
- Clinically dehydrated
What Tx are contraindicated with bronchiolitis
- nebulised hypertonic saline
- bronchodilators
- steroids
- Abx
At what gestation is RSV vaccine recommeded in pregnant women
28 weeks
How long does the RSV antibodies last in a baby
first 6 months of life
Bronchiolitis Mx
Respiratory support
- Low-flow oxygen (e.g., 2 litres via nasal cannula)
- High-flow humidified oxygen via a tight nasal cannula (e.g., “Airvo” or “Optiflow”)
- Continuous positive airway pressure (CPAP)
- Intubation and ventilation
To increase PEEP
CXR findings for RSV pneumonia
- hyperinflation
- peribronchial thickening
- patchy infiltrates
When is an ACG indicated for children with bronchiolotis
when supplemental O2 conc. is >50%
MX for poor oral intake children in bronchiolitis
NG fluids/feed
Bronchiolitis RED FLAGS
- worsening work of breathing (e.g. grunting, nasal flaring, marked chest recession)
- fluid intake is 50% to 75% of normal
- Dehydration not wetting nappy for 12 hours
- apnoea or cyanosis
- exhaustion (for example, not responding normally to social cues, wakes only with prolonged stimulation).
RSV pneumonia presentations
- Severe respiratory distress
- high fever (above 390
- productive cough
- hypoxia
- cyanosis
- Lethargy
- Poor feeding
