1 / 16

BRONCHIOLITIS

BRONCHIOLITIS. Dr Jonny Taitz, FRACP Geschn Paediatrician Sept 2003. What is it?. Lower respiratory tract infection Infants < 1 yr Leads to air trapping & airway obstruction 90% RSV bronchiolitis Most causes are self limiting. Diagnosis. Clinical Nasal obstruction Runny nose Cough

Jims
Download Presentation

BRONCHIOLITIS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. BRONCHIOLITIS Dr Jonny Taitz, FRACP Geschn Paediatrician Sept 2003

  2. What is it? • Lower respiratory tract infection • Infants < 1 yr • Leads to air trapping & airway obstruction • 90% RSV bronchiolitis • Most causes are self limiting

  3. Diagnosis • Clinical • Nasal obstruction • Runny nose • Cough • Fever cough • Apnoea (particularly neonates)

  4. Respiratory Distress • Mild Clinical Signs: • Moderate • Severe • Greatest risk: • Very young • Prem/LBW • Underlying heart/lung problems

  5. Respiratory Distress (contd) •  RR . Very important clinical finding. • Tug/recession • Cyanosis • Flaring • Grunt

  6. Tests • Nil specific • Consider: • NPA for respiratory viruses • CXR • FBC • B/C • NONE are routine

  7. What else can this be ?!? Pneumonia CXR,  Fever, “toxic” Asthma familiy hx, no fever, bronchodilator response, older children Heart Failure HR, murmurs, big liver Pneumothorax CXR, deviated trachea Foreign Body hx, choking, unilateral signs Differential DX

  8. Management Is Respiration effective? No Yes 100% FM02 - Mild Bag/mask ventilation - Moderate NETS/PICU - Severe Intubate & ventilate

  9. Mild Bronchiolitis • Feeding normally • Little respiratory distress • Fever less than 385C (50%) • No O2 requirements •  D/C home

  10. Moderate Bronchiolitis • SOB, poor feeding • Moderate respiratory distress • Short, self limiting Apnoeas • Need O2 to keep sats > 95% • Fever •  admit, Paediatrician where possible • O2, IV fluids • Observation sats NB • NPA ± CXR

  11. Severe Bronchiolitis • Unable to feed • Severe respiratory distress • Tiring! Frequent & prolonged Apnoea • Maximum O2 UNABLE to keep sats up • Fever •  NETS, CICU • NBM, IV fluids • CXR, NPA, ABG • Monitor, intubate, ventilate

  12. Issues in Bronchiolitis • O2 • Mainstay of treatment • Aim for sats > 95% on initial presentation • Sats > 92% on D/C • Fluids • Feeds if tolerated • NBM • IV fluids • Maintenance

  13. Issues in Bronchiolitis (contd) • Drugs • NOT helpful • Trial of bronchodilator and review • Antibiotics unhelpful • Antivirals • Steroids • PhysioRx • Contraindicated

  14. Issues in Bronchiolitis (contd) • Cross infection prevention • NB Nursing issues • Value of repeated regular observations critical in effective management!

  15. Take Home Message • O2 is the key • Regular & repeated observation • NO role for medication • Watch out for: • Prems • LBW • Congenital heart disease • Chronic lung disease • Wide spectrum of presentations

  16. Questions

More Related