Bronchiolitis Flashcards
stridor is pathognomonic for upper aiway ___
narrowing
theres a tendency for the airway to ___ when you breathe in
inspiration
wheeze is an ____ sounds due to intra-thoracic dynamic airway ___. such as:
wheeze is an EXPIRATORY sound due to intra-thoracic dynamic airway collapse.
- astham or bronchiolitis
crackles are inspiratory or expiratory and are intermittent. sounds like ____
velcro
If someone presents with RTI/bronchiolitis, who does poorly?
huge factor that increases the number of infections/bronchiolitis per year
if they are in day care
this to check on PE and history if you suspect a LTI or bronchiolitis
- can they complete sentences?
- vitals
- saturation
- RR and HR!
normal resp rates for infants
30-60
inspiratory muscle use/indications that there is labored breathing
expiratory muscles
inspiratory: nasal flare
scalenes and SCM
tripodding; pec pulls chest wall open
intercostals
expiratory: abdominal muscles
definition of bronchiolitis
VIRAL infection of the lower respiatory tract characterized by inflammation, edema and necrosis of epithelial cells lining small airways, increased mucus production and bronchospasm
epidemiology bronchiolitis
at 2 years, 90% have had RSV
in addition to RSV, what other viruses cause bronchiolitis
human metapneumoviris, para influenzea, influenza, adenovirus
bronchiolitis pathophysiology
mucus buildup and inflamed tissue. causes necrosis and loss of epithelium. constriction. smooth muscle tightens around bronchiole tubes. alveoli collapse
ex/ in RSV. major mucus and inflammation causes cell to sluff off (necrotize) and then clog everything up. Causes “synsytium”
RSV clinical course of bronchiolitis
- incubation period (2-8 days)
- upper respiratory infection: 1-3 days
- worsening lower airway disease: 3-5 days
- full recovery: 2-8 weeks
baby presents with wheeze. you suspect bronchiolitis and want to admit the child. what tests?
chest radiograph
blood gas
complete blood count
electrolyes
viral culture
” for sure” treatment for bronchiolitis
oxygen and supportive care.
- there is less evidence for steroids and bronchodilators. some still give this.
- nebulized epi reduced day 1 admission rate, not much of an effect.
steroids+ epi-neb might reduce re-admission, but most still got admitted.
- no evidencce for antibiotics, anticholinergics.
for kids with bronchiolitis who are really sick, you need to maintain adquate ____
adequate PEEP. Maintain airway patency at end expiration. prevents airway collapse. gives inspiratory pressure and maintains resistance on airway to prevent collapse.
RSV link to chronic resp disease
rsv may increase risk of long tem asthma.
differentiating astham vs bronchioloitis
- is wheeze lasts over 9 months, think astham.
- this is important to differentiate because asthma can be treated by long term inhaled cortcosteroids, whereas there is no benefit to steroids for bronchiolitis
R
