Paeds: Bronchiolitis Flashcards
What organism most commonly causes bronchiolitis?
RSV
What is the age range for bronchiolitis
Age up to 2 years
Most commonly 3-6 months
When to consider an alternative diagnosis other than bronchiolitis
Fever > 39
Focal findings
Concerning features to ask about in bronchiolitis
Apnoeas
Cyanosis
Differentials of bronchiolitis to consider
Pneumonia
VIW/Asthma
Inhaled foreign body
Pulmonary oedema
When does bronchiolitis peak?
3-5 days into the illness
I.e. tell parents they get worse before they get better
What is the management of bronchiolitis?
Include specific points for severe bronh
Mainstay is supportive treatment
- Comfortable position
- Oxygen if needed
- NG feeding if needed
- IV fluids if dehydrated
Consider upper airway suctioning if unable to feed or having apnoeas
Can also try saline nasal drops
High flow nasal cannulae can be considered if needing to splint open the airway. Reduces need for CPAP
Consider taking a gas from an unwell baby - e.g. to look at CO2
Ventilation is obviously a last resort in the most unwell
No benefit has been shown from any other interventions including nebs or steroids
Immunising against RSV
Initially RSV immunoglobulin, now they use a monoclonal antibody
Given to those at highest risk of death from RSV/bronchiolitis
- Congenital heart disease
- Chronic lung disease due to prematurity
- High risk immunodeficiency
Managing the unwell bronchiolitis baby in resus
Take them in to resus
Get them in a good position where they are most settled - on the bed or with mum
Get oxygen on them
Assess for the signs of IWOB, CRT and shock
Ask about apnoeas and PMH/prematurity
If needed consider suction of the upper airway (although this is more for when they’re feeding rather than an acute intervention in most cases)
Consider taking a gas and getting access
If really struggling consider high flow nasal cannulae
If very, very worried consider calling for help with intubation/ventilation
Pass an NG
