Bronchiolitis Flashcards
What is bronchiolitis?
Viral LRTI usually affecting children under 12 months
When is peak severity of bronchiolitis? When does illness resolve?
Peak illness D2-3
Resolves in 7-10 days
Symptoms of bronchiolitis
Cough Tachypnoea Retractions Widespread crackles or wheeze Fever
Risk factors for more severe illness
Chronological age <10 weeks Chronic lung disease Congenital heart disease Chronic neurological conditions Indigenous ethnicity Immunodeficiency Trisomy 21
Mild severity bronchiolitis
Behaviour: Normal Respiratory rate: Normal Use of accessory muscles: Nil to mild chest wall retraction SpO2: >92% Apnoeic episodes: None Feeding: Normal
Moderate severity bronchiolitis
Behaviour: Some/intermittent irritability
Respiratory rate: Increased
Use of accessory muscles: Moderate chest wall retractions, suprasternal retraction, nasal flaring
SpO2: 90-92%
Apnoeic episodes: May have brief apnoea
Feeding: May have difficulty with feeding or reduced feeding
Severe bronchiolitis
Behaviour: Increasing irritability and/or lethargy, fatigue
Respiratory rate: Marked increase or decrease
Use of accessory muscles: Marked chest wall retractions, marked suprasternal retraction, marked nasal flaring
SpO2: <90%, may not be corrected with supplemental oxygen
Apnoeic episodes: May have increasingly frequent or prolonged apnoeas
Feeding: Reluctant or unable to feed
What is the suggested threshold for commencing NG feeds in bronchiolitis?
<50% intake over 12 hrs
What is the threshold for commencing supplemental O2 in bronchiolitis?
SpO2 <90%
What is the appropriate escalation of forms of respiratory support in bronchiolitis?
NP
HFNP
CPAP
When should oxygen saturation monitoring be ceased?
When not requiring oxygen for >2hrs
Continue other 2-4hrly observations, reinstate intermittent oxygen monitoring if deterioration occurs
At what volume should IV or NG fluids be commenced if needed?
2/3 maintenance
