Bronchiolitis Management Flashcards
When should you immediately refer (call 999) a child with bronchiolitis?
Immediate referral (call 999) should be made if there is apnoea (observed or reported), the child looks seriously unwell, severe respiratory distress (e.g. grunting, marked recession, RR > 70/min), or central cyanosis.
When should you consider referring a child with bronchiolitis?
Consider referring if respiratory rate >60/min, difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume), clinical dehydration (CRT >3s, reduced skin turgor, dry mucous membranes, reduced urine output), or persistent oxygen saturation < 92% on air.
When should you admit a child with bronchiolitis?
Admit if there is apnoea (observed or reported), persistent low O2 saturations (< 92% on RA for babies under 6 weeks, or children of any age with underlying health conditions, < 90% on RA for children aged 6 weeks and over), inadequate fluid intake (50-70% of normal), or features of severe respiratory distress (e.g. grunting, chest recession, RR > 70). Lower threshold to admit for infants with risk factors for severe bronchiolitis.
How is bronchiolitis diagnosed?
Bronchiolitis is a clinical diagnosis.
Should blood tests be routinely performed when assessing a baby with bronchiolitis?
Do not routinely perform blood tests when assessing a baby with bronchiolitis.
Should chest x-rays be routinely performed in babies with bronchiolitis?
Do not routinely perform a chest x-ray in babies with bronchiolitis, because changes on x-ray can mimic pneumonia.
What is the respiratory management for bronchiolitis?
Respiratory management for bronchiolitis includes humidified oxygen, CPAP, and upper airway suction.
When should humidified oxygen be given to children with bronchiolitis?
Humidified oxygen should be given if saturation is persistently low (< 92% for babies under 6 weeks or children of any age with underlying health conditions, < 90% for children aged 6 weeks and over).
When should CPAP be considered for children with bronchiolitis?
CPAP should be considered if there is impending respiratory failure.
When should upper airway suction be performed in children with bronchiolitis?
Upper airway suction should not be performed routinely, but should be done if upper airway secretions are causing respiratory distress or feeding difficulties.
How should fluids be managed in children with bronchiolitis who cannot take enough fluid by mouth?
Fluids should be given by nasogastric/orogastric tube if they cannot take enough fluid by mouth. IV fluids should be given if they cannot tolerate nasogastric or orogastric fluids or have impending respiratory failure.
What infection control measures are required for bronchiolitis patients on the ward?
Infection control measures are required in the ward the patient is placed as RSV is highly infectious.
What monoclonal antibody can reduce the number of hospital admissions in high-risk preterm infants with bronchiolitis?
Palivizumab (monoclonal antibody against RSV) reduces the number of hospital admissions in high-risk preterm infants.
What should parents be advised about the diagnosis of bronchiolitis?
Explain that bronchiolitis is a common chest infection that affects about 1 in 3 children under 1 year old and usually gets better by itself over 2 weeks.
What should parents be advised to do for managing bronchiolitis at home?
Advise maintaining good hydration and using paracetamol if the child is over 3 months old and distressed.
