Respiratory conditions Flashcards
Presentation of bronchiolitis
- Coryzal symptoms. These are the typical symptoms of a viral upper respiratory tract infection: running or snotty nose, sneezing, mucus in throat and watery eyes.
- Signs of respiratory distress
- Dyspnoea (heavy laboured breathing)
- Tachypnoea (fast breathing)
- Poor feeding
- Mild fever (under 39ºC)
- Apnoeas are episodes where the child stops breathing
- Wheeze and crackles on auscultation
Brochiolitis occurs in what age of children? Most common in what age?
under 1 year
It is most common in children under 6 months.
It can rarely be diagnosed in children up to 2 years of age, particularly in ex-premature babies with chronic lung disease.
Signs of respiratory distress
- Raised respiratory rate
- Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
- Intercostal and subcostal recessions
- Nasal flaring
- Head bobbing
- Tracheal tugging
- Cyanosis (due to low oxygen saturation)
- Abnormal airway noises
Aetiology of bronchiolitis
When a virus affects the airways of adults, the swelling and mucus are proportionally so small that it has little noticeable effect on breathing.
The airways of infants are very small to begin with, and when there is even the smallest amount of inflammation and mucus in the airway it has a significant effect on the infants ability to circulate air to the alveoli and back out. This causes the harsh breath sounds, wheeze and crackles heard on auscultation when listening to a bronchiolitic baby’s chest.
causes of bronchilotis (most common)
virus.
Respiratory syncytial virus (RSV) is the most common
definition of bronchiolitis
inflammation and infection in the bronchioles, the small airways of the lungs.
- What are the 3 abnormal airway noises to be aware of in children
- Wheezing is a whistling sound caused by narrowed airways, typically heard during expiration
- Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure
- Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup
- Criteria for admission in bronchiolitis
- Aged under 3 months or any pre-existing condition such as prematurity, Downs syndrome or cystic fibrosis
- 50 – 75% or less of their normal intake of milk
- Clinical dehydration
- Respiratory rate above 70
- Oxygen saturations below 92%
- Moderate to severe respiratory distress, such as deep recessions or head bobbing
- Apnoeas
- Parents not confident in their ability to manage at home or difficulty accessing medical help from home
- Typical RSV course
- starts as an upper respiratory tract infection (URTI) with coryzal symptoms.
- From this point around half get better spontaneously.
- other half develop chest symptoms over the first 1-2 days following the onset of coryzal symptoms.
- Symptoms are generally at their worst on day 3 or 4.
- Symptoms usually last 7 to 10 days total and most patients fully recover within 2 – 3 weeks
Management of bronchiolitis
Typically patients only require supportive management. This involves:
- Ensuring adequate intake. This could be orally, via NG tube or IV fluids depending on the severity. It is important to avoid overfeeding as a full stomach will restrict breathing. Start with small frequent feeds and gradually increase them as tolerated.
- Saline nasal drops and nasal suctioning can help clear nasal secretions, particularly prior to feeding
- Supplementary oxygen if the oxygen saturations remain below 92%
- Ventilatory support if required
There is little evidence for treatments such as nebulised saline, bronchodilators, steroids and antibiotics.
- Children who have had bronchiolitis as infants are more likely to have….. during childhood.
viral induced wheeze
- How long do bronchiolitis symptoms last usually?
7 to 10 days total and most patients fully recover within 2 – 3 weeks
- Most patients with bronchiolitis fully recover within ..
2-3 weeks
- Ventilatory support : when is it needed?
As breathing gets harder, the child gets more tired and less able to adequately ventilate themselves.
They may require ventilatory support to maintain their breathing. This is stepped up until they are adequately ventilated:
- Ventilatory support: different escalations
- **High-flow humidified oxygen **via tight nasal cannula (i.e. “Airvo” or “Optiflow”). This delivers air and oxygen continuously with some added pressure, helping to oxygenate the lungs and prevent the airways from collapsing. It adds “positive end-expiratory pressure” (PEEP) to maintain the airway at the end of expiration.
- Continuous positive airway pressure (CPAP). This involves using a sealed nasal cannula that performs in a similar way to Airvo or Optiflow, but can deliver much higher and more controlled pressures.
- Intubation and ventilation. This involves inserting an endotracheal tube into the trachea to fully control ventilation.
