Bronchiolitis

Question 1

Definition

Answer 1

Generalised LRTI with widespread wheeze

Question 2

Epidemiology

Answer 2

Most common LRTI infants
50% in first 2 years
+Winter
+incidence of asthma later in life

Question 3

Etiology

Answer 3

Viral most commonly

RSV (which can also cause lobar pneumonia)

Question 4

Clinical features

Answer 4

Cough
Wheeze
Tachypnea
Apnea

Food feeding
Fever
Respiratory distress

Crackles + wheeze

Question 5

Diagnosis

Answer 5

Age

Question 6

Assessment of severity: severe, moderate, mild

Answer 6

Severe:

• ++WOB
• Fi)2 >0.5 to keep O2 >92%
• poor feeding
• apnoiec episodes

Moderate:

• Some +WOB
• reduced fluid
• SpO2

Mild:
Normal behaviour, TT, no respiratory accessory, normal feeding, no oxygen requirement

Question 7

Management

Answer 7

Diagnosis
Assess severity
1. Severe–>Oxygen, keep 02% >92%. Fluids IV at 75% maintenance. Monitor in ICU. Consider nasal/ETT CPAP or ventilation
2. Moderate–>
-Admit, single room
-Minimal handling
-Observe closely 1-2 hourly
-Give O2 to keep >92%
-Monitor fluid, use IV/NG as required up to 75% maintenance as risk of SIADH
-D/C when appropriate
3. Mild–>
-Home treatment
-Advise about expected course, return if any problems
-Patient information
-Monitor fluids->small feeds frequently (maybe hourly)
-Advise medical review if early in disease
-Avoid respiratory “toxins”
-Avoid visiting other babies
-Panadol for discomfort
-Plan early review particularly in those with risk factors

Ensure breast feeding support

Question 8

When to discharge

Answer 8

Feeding +
Normal/near normal WOB
No requirements for supplemental oxygen

Question 9

History

Answer 9

Age
Contact with LRTI
Coryza/URTI
Cough
Wheeze/crackles
Decreased feeding->feeding and urine output
Apnea, colour change
Risk factors
Duration->get worse before better

FH atopy, eczema, asthma->tends to be more common, risk of developing asthma
Exposure to smoking

Question 10

Peak severity, resolution, cough persistence

Answer 10

Day 2, 3, 5
Resolution 7-10 days
Cough may persist for weeks 4

Question 11

Risk of severe disease

Answer 11

Age

Question 12

Examination

Answer 12

General inspection
Vitals
\+/- coryza
\+WOB
Signs of dehydration
Apnoeic episodes
Wheeze, crepitations, AE->diffuse crackles

Question 13

Use of bronchodilators

Answer 13

May be trialled in older, or family history

Usually not responsive

Question 14

How to ensure minimal handling

Answer 14

Cluster observations, investigations, nappy change and feeds

Question 15

If pale, grunting what should you consider

Answer 15

Pnemonia and ?CXR

Question 16

Supportive therapy

Answer 16

Fluids
Paracetamol
Humidified oxygen
Head elevation
Suctioning of secretions
Minimal handling
Regular monitoring