Difference between revisions of "Bronchiolitis (peds)"

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==Background==
 
==Background==
 
*<2yr old (peak 2-6mo age)
 
*<2yr old (peak 2-6mo age)
**Preemies, neonates, congenital heart dz are at risk for serious disease
+
*Preemies, neonates, congenital heart dz are at risk for serious disease
*Peak in winter
+
*Peaks in winter
  
 
==Diagnosis==
 
==Diagnosis==
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**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
 +
*Duration = 7-14d (worst during days 3-5)
  
 
==Work-Up==
 
==Work-Up==

Revision as of 03:25, 22 June 2011

Background

  • <2yr old (peak 2-6mo age)
  • Preemies, neonates, congenital heart dz are at risk for serious disease
  • Peaks in winter

Diagnosis

  • Symptoms
    • Rhinorrhea, cough, irritability, periods of apnea (neonates)
  • Signs
    • Tachypnea, cyanosis, wheezing, retractions
    • Fever is usually low-grade or absent
      • If high-grade fever consider OM, UTI
  • Duration = 7-14d (worst during days 3-5)

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

DDx

  1. Asthma
  2. PNA
  3. FB
  4. Pertusis
  5. CHF
  6. Cystic fibrosis
  7. Vascular ring
  8. CA


Treatment

  1. O2 (maintain SaO2 >90%)
  2. Racemic epi neb
    1. Only repeat if initial beneficial response
  3. Suction nares
  4. No steroids

Disposition

Consider admission for:

  1. Underlying heart/lung disease
  2. Preterm (<34wks)
  3. Age <3months
  4. Initial SaO2 <92%
  5. Unable to tolerate PO

See Also

Source

Rosen's, Tintinalli