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BRONCHIOLITIS
Dr Jonny Taitz, FRACP
Geschn Paediatrician
Sept 2003
What is it?
 Lower respiratory tract infection
 Infants < 1 yr
 Leads to air trapping & airway obstruction
 90% RSV bronchiolitis
 Most causes are self limiting
2
Diagnosis
 Clinical
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Nasal obstruction
Runny nose
Cough
Fever cough
Apnoea (particularly neonates)
3
Respiratory Distress
 Mild
 Moderate
 Severe
 Greatest risk:
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Clinical Signs:
Very young
Prem/LBW
Underlying heart/lung problems
4
Respiratory Distress
(contd)
  RR . Very important clinical finding.
 Tug/recession
 Cyanosis
 Flaring
 Grunt
5
Tests
 Nil specific
 Consider:
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NPA for respiratory viruses
CXR
FBC
B/C
NONE are routine
6
Differential DX
 What else can this be ?!?
 Pneumonia
CXR,  Fever, “toxic”
 Asthma
familiy hx, no fever,
bronchodilator response,
older children
 Heart Failure
 Pneumothorax
 Foreign Body
 HR, murmurs, big liver
CXR, deviated trachea
hx, choking, unilateral signs
7
Management
Is Respiration effective?
No
Yes
100% FM02
Bag/mask ventilation
NETS/PICU
Intubate & ventilate
- Mild
- Moderate
- Severe
8
Mild Bronchiolitis
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Feeding normally
Little respiratory distress
Fever less than 385C (50%)
No O2 requirements
 D/C home
9
Moderate Bronchiolitis

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SOB, poor feeding
Moderate respiratory distress
Short, self limiting Apnoeas
Need O2 to keep sats > 95%
Fever
 admit, Paediatrician where possible
O2, IV fluids
Observation sats NB
NPA ± CXR
10
Severe Bronchiolitis

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Unable to feed
Severe respiratory distress
Tiring! Frequent & prolonged Apnoea
Maximum O2 UNABLE to keep sats up
Fever
 NETS, CICU
NBM, IV fluids
CXR, NPA, ABG
Monitor, intubate, ventilate
11
Issues in Bronchiolitis
 O2



Mainstay of treatment
Aim for sats > 95% on initial
presentation
Sats > 92% on D/C
 Fluids
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Feeds if tolerated
NBM
IV fluids
Maintenance
12
Issues in Bronchiolitis
(contd)
 Drugs
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NOT helpful
Trial of bronchodilator and review
Antibiotics unhelpful
Antivirals
Steroids
 PhysioRx

Contraindicated
13
Issues in Bronchiolitis
(contd)
 Cross infection prevention
 NB Nursing issues
 Value of repeated regular
observations critical in effective
management!
14
Take Home Message

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O2 is the key
Regular & repeated observation
NO role for medication
Watch out for:
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Prems
LBW
Congenital heart disease
Chronic lung disease
 Wide spectrum of presentations
15
Questions
16
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