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Bronchiolitis - Coggle Diagram
Bronchiolitis
Clinical features
coryzal sx 1st
sharp dry cough
SOB
feeding difficulty
recurrent apnoea = serious comp esp in young infants
tachypnoea
subcostal + intercostal recession
chest hyperinflation
prominent sternum
liver displaced downwards
fine end inspiratory crackles
high pitched wheeze
prolonged expiration
tachycardia
cyanosis
pallor
Pathogens
RSV in 80%
human metapneumovirus
parainfluenza
rhinovirus
adenovirus
influenza
mycoplasma pneumoniae
dual infection of RSV + human metapneumovirus a/w severe bronchiolitis
Management
supportive
humidified O2 via nasal cannulae
monitor for apnoea
NG/IV fluids
CPAP or full ventilation required in a small %
IPC (esp hand hygiene) as RSV is highly infectious
Intro
commonest serious resp infection of infancy
annual winter epidemics
90% aged 1-9mo (rare after 1y/o)
premies with BPD, CHD or CF are more @ risk of severe bronchiolitis
Investigations
PCR of NP secretions
pulse oximetry
Capill blood gas if severe to identify hypercarbia + need to additional ventilatory support
CXR rarely helpful
chest hyperinflation
flattening of diaphragm
horizontal ribs
increased hilar bronchial markings
Prognosis
most recover within 2wks
up yo 50% will have recurrent episodes of cough + wheeze
rare comp = bronchiolitis obliterans
permanent airway damage
usually after adenovirus
Prevention
Palivizumab
monoclonal ab to RSV
monthly IM injection
given to high risk premies
use limited by cost + need to multiple injections
