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Paediatrics > Bronchiolitis > Flashcards

Bronchiolitis Flashcards

1
Q

What is bronchiolitis?

A

Viral LRTI generally affecting children under 12m. Most frequent cause of hospitalisation in children less than 6m. Consider overlap with asthma if 12m+

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2
Q

What are the risk factors for severe bronchiolitis?

A
  • Young (esp less 6w)
  • Ex premi
  • CHD
  • Neurological conditions
  • Chronic respiratory illness
  • Pulmonary HTN
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3
Q

Describe the time course of bronchiolitis

A
  • Peak severity D2-3
  • Illness resolution over 7 - 10d
  • Cough may persist for weeks
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4
Q

What are the PEx features of bronchiolitis?

A
  • Increased WOB
  • Widespread wheeze and creps
  • +/- fever
  • +/- dec SaO2
  • Assess for dehydration
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5
Q

What are the signs of moderately severe bronchiolitis?

A
  • Irritable
  • Inc RR, tracheal tug, nasal flaring
  • Mod chest wall retraction
  • Reduced feeding
  • Mild hypoxemia (90-93%)
  • +/- brief apnoeas
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6
Q

What are the signs of severe bronchiolitis?

A
  • Irritability / lethargy / fatigue
  • Marked inc or dec in RR
  • Marked chest wall retraction
  • Reluctant or unable to feed
  • Hypoxemia: less 90%
  • May have more frequent or prolonged apnoeas
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7
Q

What investigations are required in bronchiolitis?

A

Most children: NO investigations.

  • NPA: not routine
  • CXR: not routine unless diagnostic uncertainty / local signs.
  • Blood gas: not routinely required
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8
Q

What are the typical features of bronchiolitis on CXR?

A
  • Hyperinflation
  • Peribronchial thickening
  • Patchy consolidation / collapse
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9
Q

What is the general approach to acute management of bronchiolitis?

A

Supportive:

  • oxygenation
  • maintain fluids
  • minimal handling
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10
Q

How is mild bronchiolitis managed?

A
  • Home Mx
  • Advise parents of expected course, when to return
  • Give info leaflet
  • Smaller, frequent feeds
  • Further Rv if:
  • -early
  • -RFx present
  • -increasing signs of severity develop
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11
Q

How is moderate bronchiolitis managed?

A
  • Discuss with paeds for admission
  • O2 maintain 92%+
  • Consider limiting fluids to 2/3 maintenance
  • 1-2h obs
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12
Q

How is severe bronchiolitis managed?

A
  • Cardioresp monitoring
  • Close nursing
  • Supplemental O2 and fluids
  • Consider tertiary transfer with ICU facilities
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13
Q

When should child be transferred to tertiary centre?

A
  • Severe
  • Comorbidities (e.g. premi)
  • Apnoeas
  • Children needing care above comfort of hospital
  • O2 requirement 50%+
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14
Q

Do bronchodilators have a role in bronchiolitis?

A

Do not alter course of acute bronchiolitis. Some evidence for neb saline but not standard therapy.

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15
Q

Are ABx indicated for bronchiolitis?

A

Not for uncomplicated bronchiolitis.

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16
Q

What are the CFx of bronchiolitis?

A
  • Cough
  • Tachypnoea
  • Poor feeding
  • Wheeze
  • Crackles
  • Apnoea
  • Mucous production and inflammation causing obstruction at level of bronchioles.
17
Q

Hx features to elicit in bronchiolitis assessment?

A
  • Age
  • Duration (peak 3-5d)
  • Hx prematurity
  • PMHx
  • Recent intake / output
  • FHx atopy / asthma
  • Apnoea: #, frequency, duration
18
Q

What must be assessed and documented in PEx for bronchiolitis admission?

A
  • Temperature
  • RR
  • HR
  • BP
  • SPO2 and/or Oxygen requirements
  • Pain
  • Level of Respiratory Distress
  • Central and Peripheral
  • Capillary Refill Time
  • Colour – i.e.: pink, pale, grey, cyanosed, flushed
    Feeding / Hydration Status / urine output
  • Level of consciousness / irritable/ consolable etc
19
Q

What are the potential indications for NPA in bronchiolitis?

A
  • Hx of apnoeas
  • severe or atypical illness
  • clinical suspicion of pertussis
20
Q

Which viruses are most commonly responsible for bronchiolitis?

A
  • RSV

- Human metapneumovirus

21
Q

What is the only intervention demonstrated to improve the condition of children with bronchiolitis?

A

Supplemental oxygen.

Mx thus centres around symptomatic relief, hydration and oxygenations.

22
Q

What are the supportive care management strategies?

A
  • Humidified oxygen
  • Hydration maintenance
  • Mechanical ventilation
  • Nasal and oral suctioning
  • Apnoea and cardiorespiratory monitoring
  • Temp regulation in small infants
23
Q

What are bronchioles?

A

Small airways

24
Q

What is the bronchiolar lining comprised of?

A
  • surfactant secreting Clara cells

- neuroendocrine cells (somatostatin, endothelin, serotonin)

Paediatrics (31 decks)

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