Bronchiolitis (peds): Difference between revisions
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*Preemies, neonates, congenital heart dz are at risk for serious disease | *Preemies, neonates, congenital heart dz are at risk for serious disease | ||
*Peaks in winter | *Peaks in winter | ||
*Duration = 7-14d (worst during days 3-5) | |||
==Diagnosis== | ==Diagnosis== | ||
*Symptoms | *Symptoms | ||
**Rhinorrhea, cough, irritability, | **Rhinorrhea, cough, irritability, apnea (neonates) | ||
*Signs | *Signs | ||
**Tachypnea, cyanosis, wheezing, retractions | **Tachypnea, cyanosis, wheezing, retractions | ||
**Fever is usually low-grade or absent | **Fever is usually low-grade or absent | ||
***If high-grade fever consider OM, UTI | ***If high-grade fever consider OM, UTI | ||
* | *Assess for dehydration (tachypnea may interfere with feeding) | ||
==Work-Up== | ==Work-Up== | ||
| Line 34: | Line 35: | ||
#Vascular ring | #Vascular ring | ||
#CA | #CA | ||
==Treatment== | ==Treatment== | ||
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#Racemic epi neb | #Racemic epi neb | ||
##Only repeat if initial beneficial response | ##Only repeat if initial beneficial response | ||
#Suction nares | #+/- albuterol | ||
# | #Suction nares / nasal saline drops | ||
#Steroids are controversial (?efficacy) | |||
==Disposition== | ==Disposition== | ||
Consider admission for: | Consider admission for: | ||
#Age <3months | |||
#Preterm (<34wks) | |||
#Underlying heart/lung disease | #Underlying heart/lung disease | ||
#Initial SaO2 <92% | #Initial SaO2 <92% | ||
#Unable to tolerate PO | #Unable to tolerate PO | ||
Revision as of 03:34, 22 June 2011
Background
- <2yr old (peak 2-6mo age)
- Preemies, neonates, congenital heart dz are at risk for serious disease
- Peaks in winter
- Duration = 7-14d (worst during days 3-5)
Diagnosis
- Symptoms
- Rhinorrhea, cough, irritability, apnea (neonates)
- Signs
- Tachypnea, cyanosis, wheezing, retractions
- Fever is usually low-grade or absent
- If high-grade fever consider OM, UTI
- Assess for dehydration (tachypnea may interfere with feeding)
Work-Up
- Rapid RSV
- Obtain if <1mo old
- If positive then admit pt
- CXR
- Not routinely necessary
- May lead to unnecessary use of abx (atelectais mimics infiltrate)
- Consider if
- Diagnosis unclear
- Critically ill
- Not routinely necessary
DDx
- Asthma
- PNA
- FB
- Pertusis
- CHF
- Cystic fibrosis
- Vascular ring
- CA
Treatment
- O2 (maintain SaO2 >90%)
- Racemic epi neb
- Only repeat if initial beneficial response
- +/- albuterol
- Suction nares / nasal saline drops
- Steroids are controversial (?efficacy)
Disposition
Consider admission for:
- Age <3months
- Preterm (<34wks)
- Underlying heart/lung disease
- Initial SaO2 <92%
- Unable to tolerate PO
See Also
Source
Rosen's, Tintinalli