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Y5 Paeds > Capsule 4 - Bronchiolitis & Fever > Flashcards

Capsule 4 - Bronchiolitis & Fever Flashcards

1
Q

Cause of bronchiolitis

A

RSV

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2
Q

Proportion of kids needed to be admitted with RSV

A

1-2%

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3
Q

What is bronchiolitis

A

Swelling of bronchioles with mucus production

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4
Q

Sx of bronchiolitis

A

Coryzal symptoms & blocked nose
Reduced feeding
Cough
Wheeze / apnoeas

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5
Q

Risk factors for severe bronchiolitis

A

Chronic lung disease
Congenital heart disease
Under 3 months old
Premature
NMD
Immunodeficiency

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6
Q

What is the usual disease duration of bronchiolitis

A

7 days

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7
Q

What key Qs do you need to ask about in bronchiolitis Hx?

A

Feeding and hydration
Apnoeas - especially young babies
Risk factors for severe bronchiolitis

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8
Q

Ix for bronchiolitis

A

Clinical Ix mainly
Observations - O2 sats, temp

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9
Q

Admission criteria for bronchiolitis

A
  1. Do they need respiratory support? –> O2 sats <90% / difficulty in breathing / apnoeas
  2. Do they need feeding support? –> poor hydration or <50% of feeds
  3. Do they look sick?
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10
Q

Mx of bronchiolitis

A

Feeding support - oral (2nd = NG, 3rd = IV fluids)
Resp support - O2 sats <90%, then given O2

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11
Q

When can bronchiolitis pt be dischraged?

A

Look well, clinically stable
Sats >90%
Feeding >50% of normal
Caregiver can manage at home
Safety netting

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12
Q

When to step up care in bronchiolitis?

A

SaO2 persistently below 90% despite on O2
Signs of impending resp failure - tachypnoeic then bradypnoeic
Recurrent apnoeas
Look exhausted
Desaturations despite O2

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13
Q

How to step up in bronchiolitis?

A

Cap blood gas for resp distress
Optiflow or CPAP
Consider CXR is clinical deterioration
Talk to PICU

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14
Q

What is the approach to the febrile child?

A

Depends on age, degree of clinical concern
Can you find a cause?
Use NICE traffic light system
Identify life threatening features early

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15
Q

How can you measure fever?

A

Take parents perception of fever seriously, especially in young kids
Tools: Axillary electronic / axillary chemical dot / tympanic infra red
NOT ANYTHING ELSE - forehead strips, non touch infrared, hand on forehead

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16
Q

What features are considered in the NICE traffic light system?

A

Colour, respiration, circulation and hydration and other factors

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17
Q

What specific infections are you looking for in febrile child?

A

Meningococcal disease
Bacterial meningitis
Herpes simplex encephalitis
Pneumonia
UTI
Septic arthritis
Kawasaki disease

18
Q

Sx of Bacterial meningitis

A

Older children - stiff neck, photophobia, headache
Babies - irritability, vague symptoms

19
Q

Causative organisms of fever in under 1 month

A

(usually maternal)
GBS
E.Coli
Listeria
HSV

20
Q

Ix & initial Mx for fever in under 1 month old

A

Full septic screen - blood culture, urine culture, LP
Give full ABx within 1 hour - cefotaxime and amoxicillin
Always admit

21
Q

Causative organisms of fever in 1-3 months

A

Maternal - GBC, E.Coli, listeria
Post-natal - meningococcal, strep, staph, HiB
Viruses - RSV, enterovirus, adneovirus, HSV

22
Q

Ix for fever in 1-3 months

A

FBC, blood culture
CRP
Urine MC&S
CXR if resp signs
Stool culture if diarrhoea
LP if look unwell or have WCC out of normal range

23
Q

When do you start IV Abx in fever in 1-3 month olds

A

Child looks unwell, WCC out of normal range

24
Q

How do you get a urine sample in an under 1 year old?

A

Suprapubic aspiration with USS guidance is gold standard but rarely done
Clean catch but high chance of contamination
NOT cotton wool sample or bag sample

25
Q

Causes of fever in >3 month olds

A

Rare to get perinatally acquired infections
Meningococcal/strep/e.coli/staph/HiB
Viral - RSV/influenza etc –> HSV is the one to worry abou

26
Q

Ix for fever in >3 months old (traffic light system)

A

Red features = FBC, cultures, CRP, urine +/- LP/CXR/blood gas
Amber features = urine, bloods, maybe LP. CXR if fever >39 or WCC high
Green features = no bloods, urine test only

27
Q

Mx of fever >3 months

A

Consider period of observation in hospital
Don’t rely on decrease / lack of fever after anti-pyretics
Abx if needed - ceftriaxone
+/- acyclovir

28
Q

Tachycardia in <1 year

A

> 160

29
Q

Tachycardia in 1 to 2 years

A

> 150

30
Q

Tachycardia in 2-5 year olds

A

> 140

31
Q

Tx of fever in children

A

20ml/kg 0.9% saline bolus then reassess and ABx if shocked
If signs of meningococcal disease / unrousable, then give immediate IV ABx

32
Q

How do you discharge a febrile child?

A

Always safety net
Make judgements based on family and their social situation - consider ambulation (send home but come back in for ABx) if clinically well

33
Q

Give the green / amber / red COLOUR features of a febrile child

A

Green = normal colour
Amber = pallor
Red = mottled/pale/ashen/blue

34
Q

What are the green activity features of a febrile child?

A

Responds normally to social cues
Content/smiles
Stays awake or awakens quickly
Strong normal cry or not crying

35
Q

What are the amber activity features of a febrile child?

A

Not responding to social cues normally
No smiling
Reduced activity
Wakes only to prolonged stimulation

36
Q

What are the red activity features of a febrile child?

A

No response to social cues
Appears ill
Does not wake or stay awake
Cry is weak / high pitched / continuous

37
Q

What are the amber respiratory features of a febrile child?

A

Nasal flaring
Tachypnoea - RR >50 breaths/minute (6–12 months) OR
RR >40 breaths/minute (>12 months)
Oxygen saturation ≤95%

38
Q

What are the red respiratory features of a febrile child?

A

Grunting
Tachypnoea: RR >60 breaths/minute
Moderate or severe chest indrawing

39
Q

What are the amber circulation/hydration features of a febrile child?

A

Tachycardia: - >160 beats/minute, age <12 months OR
- >150 beats/minute, age 12–24 months OR >140 beats/minute, age 2–5 years
CRT ≥3 seconds
Dry mucous membranes
Poor feeding in infants
Reduced urine output

40
Q

What are the red circulation/hydration features of a febrile child?

A

Reduced skin turgour

41
Q

List other amber features of a febrile child

A

Age 3–6 months, temperature ≥39°C
Fever for ≥5 days
Rigors
Swelling of a limb or joint
Non-weight bearing limb/not using an extremity

42
Q

List other red features of a febrile child

A

Age <3 months, temperature ≥38°C*
Non-blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs or focal seizures

Y5 Paeds (13 decks)

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