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Pathogen, Commonly respiratory syncytial virus (RSV), initially colonizes…

- - - - Epithelial cells necrose and slough off into the airways
        
        Excess muscouse production
        
        Occlusion of airways > gas trapping
        
        decrease ventilation > decrease oxygenation of arteriolar blood
        
        Decrease oxygen saturation, Increase carbon dioxide
        
        21-22/10/2563 O2 sat 98%
        
        Narrower airways > turbulent airflow, heard on auscultation
        
        Wheeze, Rhonchi
        
        Salbutamol 1 NB + NSS up to 4 ml NB q 4 hr with prn
        
        21/10/2536 RR: 28/min
        
        Dexamethasone 8 mg IV stat
        
        Prednisolone 5mg 2tab oral pc tid.
        
        22/10/2563 RR:32-34/min
        
        Ventolin MDI 2 puff prn for dyspnea
        
        Mucous within alveoli decrease intra-alveolar surface
        
        alveolar collapse
        
        Increase inspiration air pressure within alveoli
        
        Inspiratory crackles
      - Disruption of the ciliated epithelial cells (which transport mucous out of the airways and into the pharynx, to be swallowed or evacuated)
        
        Impaired mucous clearance, for which the respiratory system tries to compensate by triggering the cough reflex
        
        Cough
        
        Bromhexine 8 mg. 1 tab oral pc tid
        
        Guaifenesin syrup 2 tsp oral pc tid
    - - Leakage of protein and fluid into the bronchi interstitium
        
        Interstitial edema
        
        Interstitial fluid accumulation around air way walls
        
        Thickend airway wall apparent on x-ray
        
        CXR : No infiltration both lung
- - - - Paracetamol 500mg 1 tab oral pc prn q 6 hr
      - 21/10/2563 BT 37.7
      - 20/10/2563 BT 37.1
  - - - Leakage of protein and fluid into the nasopharyngeal interstitium
        
        Interstitial edema
        
        Nasal congestion
        
        Coryza
        
        Cetirizine 10 mg 1 tab oral hs
  - - - 20/10/2563 CBC Normal
        
        WBC 9600 /ul
        
        RBC 5940000 /ul
        
        Hb 14 g/dl
        
        Hct 43%
        
        MCV 73 fL
        
        MCH 23.6 pg
        
        MCHC 32.5 g/dl
        
        RDW 13%
        
        Platelet count 235000 /ul
        
        Neutrophill 62 %
        
        Lymphocyte 27 %
        
        Monocyte 5 %
        
        Eosinophill 6 %
        
        Basophill 0 %