Clin Med Bronchitis, Bronchiolitis, Croup Flashcards
Type of course for viral respiratory bronchitis
self-limiting
What are common viruses that cause acute bronchitis
Influenza
parainfluenza
coronavirus
rhinovirus
How often is acute bronchitis caused by bacterial infection
not really ever
*exception in airway abnormalities like intubation and tracheostomy
How long can acute bronchitis cough last
1-2 weeks, up to 4-6 weeks
acute bronchitis S&S
- cough (w/ or w/o sputum)
- upper airway congestion, rhinitis, chest congestions
- wheezing secondary to bronchospasm
- rhonchi - clears with cough
Bronchitis vs. pneumonia
- fever
- system sx
- breath sounds
- percussion findings
- labs
Bronchitis:
- afebrile
- lack of systemic sx
- rhonchi, clear with cough
- percussion/egophany normal
- unremarkable labs typically
Pneumonia
- febrile
- chills, rigors, lack of appetite
- rhonchi, rales, decreased breath sounds
- dullness to percussion due to consolidation
- abnormal labs
How to dx. acute bronchitis
mostly clinical, no lab or radiology usually needed
Great way to distinguish between acute bronchitis and pneumonia?
CXR
- bronchitis: perihilar congestion, non-specific findings
- pneumonia: consolidations and interstitial infiltrate
When to order a CXR for respiratory issue?
Abnormal vital signs:
- tachycardia >100
- tachypnea >20
- Febrile >100.5F
- Hypoxia <92%
Two labs can be run for acute bronchitis
- CBC but imperfect test, high or low don’t make dx
- procalitonin - helps determine viral vs. bacterial etiology, released in bacterial infections, not usually used…
Symptomatic tx of acute bronchitis
- NSAIDS
- Decongestants
- Antihistamines
- Antitussives
- Mucolytics
- Bronchodilators
- Steroids
**differs slightly from Dr. Letassy
Should use Abx to tx acute bronchitis?
NO
- unless old/infirm
- artificial airway (tracheostomy)
- sx for more than 10 days
What are common upper respiratory pathogens
S. pnuemonia
H. Flu
M. cat
Bronchiolitis
- def
- results in what
Lower respiratory tract infection
- results in edema and mucous accumulation of small distal airways
Bronchiolitis etiology
Viral most common:
- RSV
- Rhinovirus
- Parainfluenza
Bronchiolitis most common population? when?
- Infants and children <2 yr
- fall and winter
Bronchiolitis risk factors
- premature <37 weeks
- <12 weeks old
- congenital dz
- immunocompromised
Bronchiolitis pathogenesis
- Terminal bronchiolar epithelial cells are damaged by virus
- Inflammation of small bronchi and bronchioles
- Edema, mucous, sloughed epithelial cells crowd airway - obstruction
Bronchiolitis
- clinical features
- typically starts as URI sx (rhinorrhea, congestion, cough)
- sx progress to fever, cough, respiratory distress
Signs of respiratory distress
- wheezing (inspiration and expiration)
- crackles
- retractions (intercostal, supraclavicular, abdominal breathing)
- nasal flaring/grunting
- Tachypnea (50-70!!!)
Bronchiolitis associated complications
- dehydration
- respiratory failure
How to dx Bronchiolitis
CXR
- usually only used on severe cases
- patchy infiltrate with perihilar congestion
- peribronchial cuffing (KNOW THIS ONE)
Lab
- RSV rapid antigen tests (quick, easy, nasopharyngeal swab)
Bronchiolitis
- how to assess severity
Frequent re-eval to assess improvement or decompensation
Bronchiolitis indications for hospitalization
- toxic appearance, lethargy, dehydration
- mod-severe respiratory distress
- hypoxia/need for supplemental O2
Bronchiolitis
- Non-severe case tx
Symptomatic tx
- nasal suctioning (very common)
- up fluids, monitor I&O
- Tylenol/ibuprofen for fever
Bronchiolitis what 2 drugs are not indicated
albuterol
steroids
Bronchiolitis
- how long do sx last
3-5 days
self-limiting
Bronchiolitis
- severe treatment
- Albuterol nebulized solution (2.5mg - 5mg)
- Nebulized hypertonic saline: secretion mobilization
- supplemental O2, intubation if necessary
- supportive care: IV, nutrition, monitorin
What is not indicated for severe Bronchiolitis tx but is often used
Oral steroids:
- Decadron (dexamethasone)
- Orapred (prednisone)
Bronchiolitis prevention
- standard precautions (hand washing, etc.)
- immunoprophylaxis: Palivizumab
Palivizumab
- what is it
- reserved for what population
- humanized monoclonal antibody vs. RSV glycoprotein
- premature infants and children or who have bronchopulmonary dysplasia
Croup
- def
Variety of upper respiratory conditions that produce a characteristic cough, inspiratory stridor, hoarseness
Croup
- etiology
- common population
- when
- Most often viral, parainfluenza most common virus
- children 3-36 months
- fall and winter months
Croup
- length of illness
3 days
Croup
- clinical feature
Anatomical narrowing of trachea in subglottic region of upper airway
Croup S&S
- barking cough
- stridor (inspiratory)
- congestion, rhinorrhea, fever
- respiratory distress
What used to score severity of croup?
Westley Croup Score
- determines score: mild, moderate, severe, impending respiratory failure
- gives guidelines of action based on score
What are the 5 criteria used in Westley Croup score?
- LOC
- Cyanosis
- Stridor
- Air Entry
- Retractions
How to dx croup
Don’t need CXR
- CXR will show “steeple” sign (subglottic airway narrowing)
How to treat mild croup
symptomatically
- cool mist humidifiers
- fever reduction
- oral fluids
- cool air (freezer/outside)
Decadron (Dexamethasone) - long half life = only need one dose
Decadron/dexamethasone dose
0.6 mg/kg
max 10 mg
How to tx moderate to severe croup
- Decadron/Dexamethasone
- Nebulized (racemic) epinephrine
- intubation if respiratory failure likely
- symptomatic control (O2, fluids, cool mist)
Nebulized racemic epinephrine dose
0.05 ml/kg per dose
max 0.5 ml
Nebulized racemic epinephrine dose
- what is it
systemic alpha and beta adrenergic agonist
- relaxation of smooth muscles of bronchial tree (beta 2 activation)
Nebulized racemic epinephrine dose monitoring
half life only 1-2 hrs
must monitor to watch for rebound effects
How to distinguish Croup from epiglottis from retropharyngeal abscess
- fever
Croup - sometimes
epiglottitis - yes
abscess - sometimes
How to distinguish Croup from epiglottis from retropharyngeal abscess
- barking cough
Croup - yes
epiglottitis - no
abscess - no
How to distinguish Croup from epiglottis from retropharyngeal abscess
- difficulty swallowing
Croup - no
epiglottitis - yes
abscess - yes
How to distinguish Croup from epiglottis from retropharyngeal abscess
- drooling
Croup - no
epiglottitis - yes
abscess - yes
How to distinguish Croup from epiglottis from retropharyngeal abscess
- throat pain
Croup - no
epiglottitis - yes
abscess -yes
How to distinguish Croup from epiglottis from retropharyngeal abscess
- trismus (lockjaw)
Croup - no
epiglottitis - no
abscess - yes
