Bronchiolitis

v.djabatey
Mind Map by , created almost 6 years ago

Paediatrics (Respiratory) Mind Map on Bronchiolitis, created by v.djabatey on 12/12/2013.

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v.djabatey
Created by v.djabatey almost 6 years ago
Laryngeal & tracheal infections
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Upper respiratory tract infection (URTI)
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Bronchiolitis
1 epidemiology
1.1 commonest serious respiratory infection of infancy
1.2 2-3% of all infants admitted to hospital/ yr during annual winter epidemics
1.3 90% of cases are 1-9 mths old
1.4 rare after 1 year of age
2 pathogen
2.1 virus
2.1.1 RSV
2.1.1.1 causes 80% of cases
2.1.1.2 highly infectious
2.1.2 human metapneumovirus
2.1.3 parainfluenza virus
2.1.4 rhinovirus
2.1.5 adenovirus
2.1.6 influenza
2.2 bacteria
2.2.1 Mycoplasma pneumoniae
3 clinical features
3.1 coryzal sx
3.1.1 followed by
3.1.1.1 dry cough
3.1.1.2 increasing breathlessness
3.2 feeding difficulty
3.2.1 assoc w/ increasing dyspnoea
3.2.1.1 often reason for hosp admission
3.3 on examination
3.3.1 sharp dry cough
3.3.2 tachypnoea
3.3.3 hyperinflation of chest
3.3.3.1 prominent sternum
3.3.3.2 liver displaced downwards
3.3.4 fine end-inspiratory crackles
3.3.5 +/- high pitched wheezes- exp> insp
3.3.6 tachycardia
3.3.7 cyanosis or pallor
3.3.8 subcostal & intercostal recession
4 complications
4.1 serious
4.1.1 recurrent apnoea
4.1.1.1 esp in young infants
4.1.1.1.1 < 4 mths old
5 high risk groups for severe bronchiolitis
5.1 premature infants
5.1.1 who developed bronchopulmonary dysplasia
5.1.2 w/ underlying lung disease
5.1.2.1 Cystic fibrosis
5.1.3 w/ congenital heart disease
6 Ix
6.1 nasopharyngeal secretions (aspirate?)
6.1.1 PCR
6.1.1.1 ID resp viruses
6.2 CXR
6.2.1 unnecessary in straightforward cases
6.2.1.1 rarely helpful in bronchiolitis
6.2.2 signs
6.2.2.1 hyperinflation of lungs
6.2.2.1.1 due to small airways obstruction
6.2.2.2 flattening of diaphragm
6.2.2.3 air trapping
6.2.2.4 focal atelectasis
6.2.2.5 horizontal ribs
6.2.2.6 increased hilar bronchial markings
6.3 pulse oximetry
6.3.1 continuous monitoring of arterial O2 sats
6.4 blood gas analysis
6.4.1 from capillary sample
6.4.1.1 done only in severe disease
6.4.1.1.1 to ID hypercarbia when additional ventilatory support is needed
7 Mx
7.1 supportive
7.1.1 humidified O2
7.1.1.1 via nasal cannulae
7.1.1.2 conc needed determined by pulse oximetry
7.1.2 monitoring
7.1.2.1 for apnoea
7.1.3 fluids
7.1.3.1 NG
7.1.3.2 IV
7.1.4 ventilation
7.1.4.1 assisted
7.1.4.1.1 nasal CPAP
7.1.4.1.2 facemask CPAP
7.1.4.2 full
7.2 infection control
8 Prognosis
8.1 most recover from acute infection within 2 weeks
8.2 1/2 will have recurrent episodes of cough and wheeze
8.3 rare
8.3.1 ff adenovirus infection
8.3.1.1 bronchiolitis obliterans
8.3.1.1.1 permanent damage to airways
9 prevention
9.1 palivizumab
9.1.1 monoclonal antibody to RSV
9.1.2 monthly i.m. injection
9.1.3 reduces risk of hosp admissions in high-risk preterm infants
9.1.4 costly
9.1.5 multiple i.m injections needed

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