Bronchiolitis

Question 1

What is the most common cause

Answer 1

Respiratory syncitial virus

Question 2

What is bronchiolitis

Answer 2

Inflammation and infection in bronchioles

Question 3

What age group does bronchiolitis occur in?

Answer 3

Children under 1 year, can be diagnosed in children up to 2 years rarely
most common in children under 6 months

Question 4

What makes children over 1 year more likely to get bronchiolitis?

Answer 4

Ex premature babies with chronic lung disease

Question 5

Why does RSV cause difficulty breathing in young children much more than adults?

Answer 5

AWs of infants are much smaller than those of adults so a small amount of inflammation and mucus in AW can have significant effect on infants ability to circulate air to alveoli and back out

Question 6

What can hear when listen to bronchiolitis chest

Answer 6

Harsh breathing sounds wheezes and crackles - inflammation and mucus

Question 7

Presentation of bronchiolitis?

Answer 7

Coryzal symptoms
Resp distress
Dyspnoea (heavy, laboured)
Tachypnoea
Poor feeding
Mild fever (under 39)
Apnoeas - episodes where child stops breathing
Wheezes and widespread fine crackles on auscultation

Question 8

Coryzal sympomts include

Answer 8

Snotty nose
Sneezing
Mucus in throat
Watery eyes

Question 9

Signs of respiratory distress

Answer 9

Raised RR
Accessory muscle use
Intercostal and sibcostal recessions
Nasal flaring
Head bob
Tracheal tug
Cyanosis
Abnormal AW noises

Question 10

Accessory muscles

Answer 10

Sternocleidomastoid
Abdo and intercostal muscles

Question 11

What are abnormal AW noises?

Answer 11

Wheeze
Grunt
Stridor

Question 12

What is a wheeze

Answer 12

Whistling sound - narrowed AWs
Expiration

Question 13

What causes grunting?

Answer 13

Exhaling with glottis partially closed to increase positive end expiratory oresssure

Question 14

What is stridor and what is it caused by?

Answer 14

High pitched inspiratory noise caused by obstruction of upper AW

Question 15

How does bronchiolitis start?

Answer 15

URTI with coryzal symptoms

Question 16

What is the outcome from original URTI?

Answer 16

50% get better spontaneously
50 % develop chest symptoms after onset of coryzal sympotms (1-2 days after)

Question 17

When are symptoms of bronchiolitis worst?

Answer 17

3-4 days
After day 5 should see improvement

Question 18

How long do symptoms last and when do children fully recover?

Answer 18

Symptoms usually last 7-10 dyas
2-3 weeks full recovery

Question 19

What children should automatically be admitted with bronchiolitis?

Answer 19

Under 3 months
Pre-existing conditions - prematurity, Downs, Cystic fibrosis, chronic lung disease, haemodynamically signficant Congenital HD, neuromuscular disorders, immunodeifciency, social background, distance to heakthcare

Question 20

Clinical signs that a child should be admitted iwth bronchiolitis?

Answer 20

50-75% of their normal intake of milk
Clinical dehydration
RR > 60 (>70 - emergency)
O2 < 92%
Mod to sev resp distress
Apnoeas
Parents not confident in ability to manage or access ot medical care from home

Question 21

Supportive management for bronchiolitis?

Answer 21

Ensuring adequate fluid intake
Saline nasal drops and nasal suctioning
Supplementary oxygen
Ventilatory support

Question 22

How to ensure adequate intake in ill child

Answer 22

Oral NG tube
IV fluids
Depends on severity

Question 23

WHy is it important to start with small frequent feeds in bronchiolitis?

Answer 23

Full stomach can restrict breathing
Increase feeds as tolerated

Question 24

Steps of ventilatory support?

Answer 24

1 - High=flow humidified oxygen
2 - Continuous positive AW pressure (CPAP)
3 - Intubation and ventilation
Do until adequate ventilation

Question 25

How do you deliver high flow humidified oxygen?

Answer 25

Tight nasal cannula Continious O2 with oressure aDDS peep

Question 26

What is PEEP?

Answer 26

Positive end expiratory pressure

Question 27

How intubate and ventilate?

Answer 27

Inserting endotracheal tube into trachea - fully control ventialtion

Question 28

What is used to monitor children on ventilatory support and in severe respiratory distress?

Answer 28

Capillary blood gas

Question 29

Poor ventilation most helpful signs

Answer 29

Rising pCO2 Falling pH

Question 30

What does rising pCO2 signifiy?

Answer 30

AWs have collapsed and cant clear waste CO2

Question 31

What does falling pH signal?

Answer 31

CO2 build up unable to buffer Repiratory acidosis

Question 32

When is someone also in type 2 resp failure with resp acidosis?

Answer 32

If also hypoxic

Question 33

How can bronchiolitis be prevented in high risk babies?

Answer 33

Monthly injection of palivzumab

Question 34

How does palivizumab work>

Answer 34

Passive immunity - doesnt avtivate babies immune system Circling antibodies for RSC - activates immune system to fight virus if encounters

Question 35

What is Palivizumab?

Answer 35

Monoclonal antibody that targets RSV

Question 36

Diagnostic criteria for bronchiolitis

Answer 36

Coryzal symptoms 1-3 dyas Persistent cough and Either tachypnoea or chest recession and either wheeze or crackles on auscultation fever, poor feeding

Question 37

When consider pneumonia over bronchiolitis?

Answer 37

High fever over 39 Persistnetly focal crackles

Question 38

When consider viral induced wheeze or early onset asthma rather than bronchiolitis in older infants and young children if they have:

Answer 38

Persistent wheeze without crackles or Recurrent episodic wheeze or personal or family history of atopy

Question 39

What conditions are rare in children under 1 that are differntials for bronchiolitis and become more likely after having ahd it?

Answer 39

Early onset astham Viral induced wheeze

Question 40

When to suspect respiratory failure in children?

Answer 40

Signs of exhaustion eg listless or decreased resp effort Recurrent apnoea Failure to maintain adequate O2 sats depite O2 supplementation

Question 41

When is it an emergency with bronchiolitis?

Answer 41

Apnoea Baby or child looks seriously unwell to healthcare professional Severe resp distress eg grunting, marked recessrion, RR >70 Central cyanosis

Question 42

What persistent oxygen sats should be admitted ot hospital when under 6 weeks

Answer 42

92% If over 6 weeks <90%

Question 43

When to discharge with bronchiolitis>

Answer 43

Clinically stable Taking adequate oral fluids Maintained O2 sats in air at following levels for 4 hours incl periods of sleep: >90% if over 6 weeks >92% if under 6 weeks or underlying health condition