Bronchioloitis + stuffy nose + CrouP Flashcards
Causes of bronchiolitis?
RSV - MC
Other causes include adenovirus parainfluenxa rihinovirus
Who does bronchiolitis affect ?
<2 year old (although usually <1 years old)
Winter period
More vulnerable infants include: Preterm, chronic lung disease, cardiac disorders, early age of onset, tabacco exposure.
How does bronchiolitis affect the airways?AA
characterised by epithelial cell destruction, cellular oedema, and airway obstruction by inflammatory debris and mucus
Signs and symptoms of bronchiolitis
Cough
Preceeded by coryxal sympotms (blocked runny nose)
Fever
Tachypnoea/increased work of breathing
We look at a few different featre when looking at increased work of breathing in babies/infants
What are they?
Subcostal recession, tracheal tug, nasal flaring, abdominal breathing, use of accessroy muscles, grunting, head bobbing
What to look for in examination
end of bed assessment
Increased work of breathing/distress
Crackeles/wheeze on the chest
struggling to feed
Snotty, congested sinuses
any rashes
Hydration
Cap refill
Tx for bronchiolitis?
1) Supplementary O2 as needed
2) NG tube/IV fluids
3) Saline neb/nasal de congestant
4) In severe cases/no improvement- optiflow/CPAP/ Senior support
TRUE or FALSE
Antibiotics/salbutamol neb work on bronchiolitis
FALSE they dont work
At what day is bronchiolitis worse?
day 3-5
What is anteror rhinoscopy?
pulling the tip of the nose and looking inside
What can you give if there is a newborn with nasal obstruction
obligate nasal breathers/ NaCl drops
What could be causing a unlateral nasal obstruction?
Foreign body, choanal atresia, adenoid, deflected septum
What could be causing a bilateral nasal obstruction
Adenoids/ allergy
Differential diagnosis for a stuffy nose
Congenital: CF/Chanal atresia/ Masses- myelocoele/meningocoele/lymphoma
Acquired: Infection- URTI/Adenoids/sinusitis, foreign body/ nasal polyps/ mucocoele
A unilateral nasal discharge in achile is consideres to be ?/??
a foreign body until proven otherwise
What is an urgent foreign body that needs to be removed urgently
Batteries because these can leak out and result in septal perforation and a cosmetic deformity
What is croup usually caused by
parainfluenza
Croup results in….
upper airway obstruction- leading to stridor and respiratory distress
What age group does croup usually affect?
children between the ages of 6 months and 3 years
Signs and symptoms of Croup
1-2 day history of preceding coryzal symptoms
sudden onsent of a barking cough
stridor (inspiratory) and voice hoarseness
Respiratory distress (eg intercostal recession)
lethargy
Mild to moderate fever
Symptoms often worse at nigh
chest sounds are usually normal (unless a secondary bacterial infection is present)
Differential DIagnosis for Croup
Epiglottis
Foreign Body inhalation
What is epiglottis caused by
Haemophylis influenxa type B
is epiglottis common or rare
Rare
Symptoms and signs of Epiglottis
Cant swallow secretions- drooling child
Tripod postion
high fever
Non barking cough
Explain the classificaiton of croup?
What is the scoring system used in croup
Westley clinical scoring systen
Explain the westley clinical scoring system
Which patients with croup need admission?
-All children with moderate, severe or impendig respiratory failure must be admitted
consider hospital admission in children with a RR of over 60 breaths per minute or who have a toxic appearance
Consider hospital admission for children with a background of chronic lung disease or co morbidities
ANy child under 3 months old with temp >38
What management for Croup in primary care
prescribe a single dose of oral dexamethasone (0.15mg/kg) to be taken immediately
encourage the use of paracetamo; and ibuprofen
encourage oral fluid intake
advise parents to check on their child through the nigh
Symptoms should resolve within 48 hrs- review if not resolved
Safety net advice
What management for Croup in secondary care
