What is Bronchiolitis? (3 things)
- Inflammation + infection of bronchioles (small airways of lungs)
- Usually viral
- Usually in infants
What is the pathophysiology of Bronchiolitis causing Narrow Aiways? (6 things)
- Lower Resp Tract cells infected
- Natural Killer cells attack
- Cytokines released
- Epithelial cells release Mucus
- Vasodilation + Fluid leaks
- Vessels swell –> Narrow airways (severe in infants who already have narrow airways)
What is the pathophysiology of Bronchiolitis causing Collapsed Aiways (Atelectasis) (3 things)
- Mucus + dead cells form Mucus plugs
- Air trapped
- Airways collapse (atelectasis)
What is the most common cause of Bronchiolitis?
Respiratory Syncytial Virus (80%)
What are the Risk Factors for Bronchiolitis? (7 things)
- Young age (under 2 yrs old)
- Nursery / Daycare attendance
- Exposure to smoking
- Premature birth
- Previous infections
- Low immunity (obv)
- Neuromuscular disorders
What are the CF of Bronchiolitis? (11 things)
Coryzal Symptoms: (typical Viral URTI symptoms) (happen first)
- Watery eyes
- Runny nose
- Sneezing
- Mucus in throat
Resp Distress Symptoms:
- Dry cough
- SOB / Tachypnoea
- Wheezing
- Cyanosis
- Using accessory muscles
Other:
- Mild fever
- Poor feeding
Which infants should be admitted to hospital w Bronchiolitis? (7 things)
- Apnoea (not breathing)
- Grunting
- RR over 70
- O2 sats under 92%
- Central yanosis
- Clinicaly dehydrated
- Age under 3 months
AGROCCA
What investigations can you do for sus Bronchiolitis? (3 things)
- CXR = patchy infiltrates + atelectasis
- PCR = suggests viral infection
- Immunofluorescence of nasopharyngeal secretions = will show RSV
What are the management options for Bronchiolitis? (5 things)
Most only need Supportive management:
- Fluids + NG tube for feeding
- Nasal suctioning / Saline nasal drops (to clear mucus)
- Humidified Oxygen (if O2 still under 92% sats)
- Intubation (if req)
Palivizumab (monoclonal antibody vs RSV, given monthly)
Who should you give Palivizumab to? (3 things)
- Prematurely born infants
- Congestige Heart Disease
- Chronic Lung Disease
