child bronchiolitis and Asthma Flashcards
Pathophysiology
Bronchiolitis
Caused by RSV (respiratory syncytial virus)
The virus replicates in epithelial cells of the bronchioles causing necrosis and shedding of the cells.
New epithelial cells not cilliated.
Lack of cillia and > secretions cause obstruction of small airways.
Impairs gaseous exchange.
Work of breathing and O2 consumption >
Diagnosis made on clinical findings.
Life long immunity usually develops following infection
Signs and symptoms
Bronchiolitis
Dry cough & wheeze Nasal discharge Low grade pyrexia Anorexia Tachycardia Tachypnoea Recession Head bobbing Nasal flaring Hypoxia Grunting Fine inspiratory crackles and/or high pitched expiratory wheeze
High Risk factors
Bronchiolitis
Born at < 35/40
< 2/12 old
Congenital heart disease / Chronic lung disease of prematurity/ other comorbidities
O2 sats < 92 % in O2
Deteriorating resp status, increasing resp distress and/or exhaustion
Recurrent apnoea
BronchiolitisManagement
Aged under 2 years – referral to appropriate facility as per EMAS protocol
Provide respiratory support as required
Treatment in hospital aims to provide respiratory support.
Antivirals, antibiotics, steroids and nebulisers have been shown to be ineffective
Asthma
Commonest reason for childhood admissions to hospital in the UK.
Children still die from asthma (04/18 to 04/19 3 deaths in EMAS after assessment and left at home)
Classic features: cough, wheeze, breathlessness.
These + difficulty in walking, talking & breathlessness = worsening asthma
Decreasing relief from bronchodilators = worsening asthma
Pathophysiology asthma
Chronic bronchial inflammation resulting in narrowing of the airways.
Acute attacks- airway irritation causes smooth muscle contraction
Excessive sputum production
Swelling of bronchial mucosal
Can be due to a trigger
Air goes in (active process) but air struggles to escape due to narrowing (wheeze thus potentially leading to hyper inflated lungs and worse cases pneumothorax)
asthma Signs, symptoms and assessment
Often difficult to assess severity.
Consider: Duration, treatment, response to treatment, course of previous attacks
Wheeze & respiratory rate are a poor indicator.
Use of accessory muscles, recession & heart rate are a better guide.
Cyanosis, fatigue & drowsiness are a late sign, often accompanied by silent chest.
Peak flow if possible and O2 saturations.
asthma High Risk patients
High risk patients include those who have:
previously been hospitalised with their asthma, especially within the last year
previously been on ITU
had back to back nebs with poor or no response
Moderate Asthma excerbation
Able to talk in sentences
SPO2 > 92 %
PEFR > 50 % best/predicted
Heart rate: < 140 / min (age 2 – 5 yrs)
< 125 / min (age > 5 yrs)
Respiratory rate: < 40 / min (age 2 – 5 yrs)
< 30 / min (> 5 yrs)
Severe Asthma
Too breathless to feed/talk Cant complete sentences in one breath Recession/use of accessory muscles Resp rate > 40 / min (age 2 – 5 yrs) > 30 / min (age > 5 yrs) Pulse rate > 140 / min (age 2 – 5 yrs) > 125 / min (age > 5 yrs) Peak flow 33 - 50 % expected best SP02 < 92 %
Life Threatening
Confusion Exhaustion Hypotension Cyanosis Poor respiratory effort O2 sats < 92 % Silent chest Peak flow < 33 % expected best
asthma Management
Oxygen
Salbutamol- Beta2 agonist. Short acting. Smooth muscle relaxation in lungs. Onset time: 5 mins.
Ipratropium bromide – Antimuscarinic (bronchodilation). 20 min onset time
Adrenaline 1:1000 IM Paramedic Only – Technician use of this drug restricted to anaphylaxis
See JRCALC
Care bundle
resp rate perf before treatment 02 before treatment beta2 02
