Bronchiolitis

Question 1

What are the signs of respiratory distress?

Answer 1

Raised respiratory rate
Use of accessory muscles
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tug
Cyanosis
Abnormal airway noises

Question 2

What is wheezing?

Answer 2

Whistling sound caused by narrow airways, typically on expiration

Question 3

What is grunting?

Answer 3

Exhaling with glottis partially closed as trying to increase the positive end-expiratory pressure in order to maintain airways that want to collapse.

Question 4

What is stridor?

Answer 4

High pitched inspiratory noise due to obstruction in the upper airway eg croup

Question 5

Bronchiolitis involves _____ and _____ in the _____

Answer 5

infection and inflammation
Bronchioles

Question 6

Bronchiolitis is generally considered to occur in infants under 1 year but most common in infants under _ months

Answer 6

6

Question 7

What is the typical course of RSV caused bronchiolitis?

Answer 7

Coryzal syx
Chest sx (1-2 days after)
Sx worsen (days 3-5)
Symptoms continue (7-10 days total)
Fully recover (within 3 weeks)

Question 8

What are reasons for admission for bronchiolitis?

Answer 8

Aged under 3 months
Pre-existing condition
Taking under 50-75% of normal fluid intake
Clinically dehydrated
Respiratory rate over 70
Oxygen stats under 92%
Apnoeas
cyanosis
Moderate resp distress

Question 9

What are auscultation findings in infants with bronchiolitis?

Answer 9

Widespread harsh breath sounds, wheezes and crackles.

Question 10

How is bronchiolitis managed?

Answer 10

Ensure adequate intake (orally, NG tube, Iv fluids) but avoid overfeeding
Saline nasal drops and suction to clear secretions particularly prior to feeding
Oxygen to keeps sats over 92%
Ventilatory support

Question 11

Describe feeding pattern that may be tolerated better for infants with bronchiolitis

Answer 11

Smaller and more frequent feeds as full stomach restricts breathing

Question 12

What is the ventilatory support ladder?

Answer 12

Low-flow oxygen

High flow humidified oxygen (tight nasal cannula with air + oxygen + pressure, prevents airway collapse)

Continuous positive airway pressure (CPAP - sealed nasal cannula with higher and more controlled pressures)

Intubation and ventilation via endotracheal tube

Question 13

What capillary blood gases may indicate inadequate ventilation in bronchiolitis?

Answer 13

Rising pCO2 (reduced clearance)
Falling pH (respiratory acidosis due to rising CO2)

Question 14

What is given to high risk babies (eg ex-premature, congenital heart disease) to protect against bronchiolitis caused by RSV?

Answer 14

Palivizumab in monthly injection.
Monoclonal antibody.
Not true vaccine as offers passive protection as antibody against virus

Question 15

Why would you want to admit a 4 month old baby with a resp rate of 64, oxygen at 93%, drinking 40% of normal fluid intake and presenting with subcostal recessions and a wheeze?

Answer 15

They are taking less than 50% normal fluid intake and will be dehydrated.

Other criteria that don’t fit here include aged under 3 months, resp rate over 70, sats under 92%.