RESP part 2

Question 1

Background for Bronchiolitis

Answer 1

Commonest respiratory infection in infants
2-3% infants admitted each year

Caused by respiratory viruses:
75-80% RSV

< 1 years
Winter months

Question 2

History of bronchiolitis

Answer 2

Coryzal illness
Cough
Increased work of breathing
Decreased feeding

Typical pattern of worsening symptoms day 3-4 of illness

Question 3

Examination of bronchiolitis

Answer 3

Coryza
Cough
Respiratory distress:
Tachypnoea
Head bobbing
Tracheal tug
Recessions
Bilateral crepitations
Bilateral wheeze

Question 4

Investigations of bronchiolitis

Answer 4

Nasopharyngeal aspirate for RSV and other resp viruses

No other investigations indicated unless severe disease or concerns re. secondary bacterial infection

Question 5

Management of bronchiolitis

Answer 5

Supportive:
1. Respiratory support:
- Oxygen
- High Flow Oxygen
- CPAP
- Mechanical ventilation
2. Feeding support:
- Small, frequent oral feeds
- Nasogastric feeds
- IV fluids

Question 6

Background of Viral induced wheeze

Answer 6

Very common in pre-school children

Many will grow out of this

Does not mean that they have asthma

Question 7

History of Viral induced wheeze

Answer 7

Coryza

Cough

Wheeze

Increased work of breathing

Question 8

Examination of viral induced wheeze

Answer 8

General:
Coryza
Cough
+/- low grade fever
+/- Difficulty speaking
Chest:
Respiratory distress
Bilateral wheeze
+/- decreased air entry

Question 9

Investigations of viral induced wheeze

Answer 9

No routine investigations as clinical diagnosis

Not for unnecessary CXR:
Common to have decreased air entry on right due to mucous plugging

Question 10

Management of viral induced wheeze

Answer 10

Airway:
Oxygen
Breathing:
Salbutamol inhalers or nebulisers
Dexamethasone if mod-severe
Circulation:
If severe/life-threatening for:
IV access
IV hydrocortisone
IV Magnesium +/- IV Aminophylline +/- IV salbutamol