Bronchiolitis Flashcards
Common age group for bronchiolitis
Any time during first year of life (12 mo)
Commonest in babies <6mo
General course of bronchiolitis?
Often starts as a runny nose, then increased difficulty in breathing
Worst - day 2-3
Often sick for 7-10 days
Cough may continue for 2-4 wks
Advice for mum looking after bronch baby at home?
> Give shorter breastfeeds more often. This way your child does not get too tired when feeding.
Avoid contact with other babies in the first few days, as bronchiolitis is an infectious disease.
STOP SMOKING
Go to hospital if baby:
- has difficulty breathing/stops breathing
- cannot feed normally because of cough/wheeze
- is changing colour in the face when they cough
- turns blue or has skin that is pale and sweaty
Risk factors for severe disease?
> Chronological age at presentation less than 10 weeks
Chronic lung disease
Congenital heart disease
Chronic neurological conditions
Indigenous ethnicity
immunodeficiency
»Infants with any of these risk factors are more likely to deteriorate rapidly and require escalation of care.
Investigations?
None indicated.
Maybe NPA PCR for epidemiology.
Management?
Respiratory support
- O2 when sats are persistently <90%
- brief desats are not a reason to commence oxygen therapy.
- O2 should be discontinued when sats are persistently >/=90%.
Hydration/nutrition
-NG or IV fluids should be at 2/3 maintenance (SIADH)
Medication
- not indicated
Nasal suction is not routinely recommended (maybe)
Nasal saline drops may be considered at time of feeding
Chest physiotherapy not indicated
Mild bronchiolitis signs/symptoms?
Behaviour = Normal
Respiratory rate = Normal – mild tachypnoea
WOB = Nil to mild chest wall retraction
Oxygen saturation = > 92% (in room air)
Apnoeic episodes = None
Feeding= Normal
Moderate bronchiolitis signs/symptoms?
Behaviour = Some / intermittent irritability
Respiratory rate = Increased
WOB = Moderate chest wall Retractions, suprasternal retraction, Nasal flaring
O2 sats= 90 –92% RA
Apnoeic episodes = May have brief apnoea
Feeding = May have difficulty with feeding or reduced feeding
Severe bronchiolitis signs/symptoms?
Behaviour = irritability / lethargy/ Fatigue
Respiratory rate=Marked increase or decrease
WOB= Marked chest wall retractions, Marked suprasternal retraction, Marked nasal flaring
O2 sats= <90% (in room air) Hypoxemia, may not be
corrected by O2
Apnoeic episodes = May have increasingly frequent or prolonged apnoea
Feeding = Reluctant or unable to feed
Management of mild bronchiolitis?
- Suitable for discharge
- Adequate assessment in ED prior to discharge (minimum 2 recorded measurements or every 4hrs)
- Small frequent feeds
- Nil O2 requirement
- Consider further medical review if early in the illness and any risk factors are present or if child develops increasing severity after discharge
- Provide advice on the expected course of illness and when to return (worsening symptoms and inability to feed adequately)
- Provide Parent information sheet
Managment of moderate bronchiolitis?
> Likely admission, may be able to be discharged after a period of observation
discussed with a local senior physician
1-2 hrly obs
If not feeding adequately (<50% over 12 hrs), administer NG hydration
Administer O2 to maintain
saturations > 90%
**Begin with NPO2,HFNC to be used only if NPO2 has failed
Decision to admit should be supported by clinical assessment (including risk factors), social and geographical factors, and phase of illness
Management of severe bronchiolitis?
> Requires admission and consider need for transfer to PICU
Hourly with continuous monitoring and close
nursing observation
If not feeding adequately
(< 50% over 12hrs),or unable to feed, administer NG hydration
Administer O2 to maintain sats >90%
Consider HFNC or CPAP
When to consider PICU review/admission?
Consider ICU review if: • Severity does not improve • Persistent desaturations • Significant or recurrent apnoea associated with desaturations • Has risk factors
History questions for bronchiolitis?
- Age - there is a higher risk of severe bronchiolitis if the child is less than 6 weeks of age
- Duration of symptoms – peak severity is usually around day 3-5 of LRTI symptoms
- History of prematurity
- History of previous medical conditions
- Recent intake and output (including feeding history)
- Family history of atopy or asthma
- Apnoea - describe number, frequency, duration
What to examine in a bronchiolitis patient?
Temperature
Respiratory rate
Heart rate
Blood Pressure
Oxygen Saturation
Pain
Level of Respiratory Distress – see ViCTOR scale
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.
