Child Health - Resp Flashcards
what is bronchiolitis?
inflammation in the bronchioles (small airways of the lungs)
what usually causes bronchiolitis?
RSV
who does bronchiolitis usually occur in?
children under 1 year
most common in kids under 6 months
can rarely occur in kids up to 2 years old (more likely in kids who were premature with chronic lung disease)
how does bronchiolitis occur?
virus affects small airways of lungs causing swelling and inflammation
airways of infants are very small compared with adults so the swelling and mucus is proportionately larger and has significant effect of the infants ability to circulate air to the alveoli and back out
how does bronchiolitis present?
harsh breath sounds wheeze and crackles coryzal symptoms signs of resp distress dyspnoea tachypnoea poor feeding mild fever (under 39) can have apnoeas
coryzal symptoms?
snotty nose
sneezing
mucus in throat
watery eyes
signs of resp distress?
raised resp rate use of accessory muscles intercostal and subcostal recessions nasal flaring head bobbing on breathing tracheal tugging cyanosis abnormal airway noises
what are the accessory muscles?
sternocleidomastoid
abdominal muscles
intercostals
types of abnormal airway noises?
wheeze (expiratory)
grunting
stridor (inspiration)
what is the typical course of RSV?
usually starts as a URTI with coryzal symptoms
from this point, half get better and other half develop chest symptoms over 1-2 days following onset of coryzal symptoms
symptoms generally worst on day 3-4 and last 7-10 days in total
most patients recover fully in 2-3 weeks
children who have bronchiolitis as infants are more likely to suffer from what as adults?
viral induced wheeze
do all infants with bronchiolitis need admission?
no
most managed at home with advise about when to seek help
when might infants with bronchiolitis need admission?
age under 3 months or any pre-existing condition such as prematurity, downs or CF reduced feeding clinical dehydration resp rate >70 oxygen sats <92 mod-severe resp distress apnoeas parents not able to manage at home or live very far from medical help
how is bronchiolitis managed?
usually only need supportive management
- ensure good intake
- saline nasal drops/nasal suctioning to help clear secretions
- oxygen
- ventilatory support if required
how can adequate intake be ensured in bronchiolitis?
can be orally
via NG tube or IV fluids depending on severity
important to avoid overfeeding so start with small frequent feeds and increase gradually
types of ventilatory support in bronchiolitis?
high flow oxygen
CPAP
intubation and ventilation
how does high flow oxygen work?
delivered via tight nasal cannula
delivers air and oxygen continuously with some added pressure helping to oxygenate the lungs and prevent airways from collapsing
adds “positive end-expiratory pressure” (PEEP) to maintain airway at end of expiration
how does CPAP work?
continuous positive airway pressure
involves using a sealed nasal cannula that performs in a similar way to a normal oxygen nasal cannula but can delivery much higher and more controlled pressures
how can ventilation be assessed?
capillary blood gases are useful in severe resp distress and in monitoring children who are having ventilatory support
what are the most useful signs of poor ventilation?
rising CO2
falling pH
what does a silent chest indicate in acute asthma?
bad sign
indicates airways are so tight that its not possible for child to move enough air through airways to create a wheeze
may be associated with a reduced respiratory effort due to fatigue
signs of moderate asthma attack?
peak flow 50-75% of predicted
increasing symptoms but not features of acute severe asthma
signs of acute severe asthma?
any one of
- peak flow 33-50% of predicted
- resp rate >25
- heart rate >110
- unable to complete sentences
signs of life-threatening asthma?
any one of
- peak flow <33% predicted
- oxygen sats <92%
- PaO2 <8
- silent chest
- cyanosis
- poor resp effort
- arrhythmia
- exhaustion
- altered consciousness
- hypotension
