ER GUIDELINES FOR bRONCHIOLITIS.pptx.ppptttt
- 1. BRONCHOILITIS MANAGEMENT GUIDELINES IN EMERGENCY • Persistent cough • Symptoms usually peak between 3 to 5 days, and the cough resolves in 90% of infants within 3 weeks. • Tachypnea and Sub costal recessions • Fever in usually 30 % of the cases is usually of less than 39 Degrees Celsius • Rhinorrhea • Poor Feeding after almost 3-5 days of illness • When diagnosing bronchiolitis, take into account that young infants with this disease (in particular those under 6 weeks of age) may present with apnea without other clinical signs.
- 2. • Apnea, toxic appearing child, lethargic. • Persistent oxygen saturation of: 1. less than 90%, for children aged 6 weeks and over 2. less than 92%, for babies under 6 weeks or children of any age with underlying health conditions • Inadequate oral fluid intake (50% to 75% of usual volume) taking account of the risk factors. • Persisting severe respiratory distress, for example grunting, marked chest recession( intercostal, subcostal or suprasternal) nasal flaring or a respiratory rate of over 70 breaths/minute assessed by examinations 15 minutes apart. • The child is exhausted due to increased work of breathing, cyanosed. • Clinically assess the hydration status of the child
- 3. • Consider performing a chest X ray if intensive care is being proposed for a baby or ‑ child. • Take into account risk factors for more severe bronchiolitis 1. Neuromuscular disorders 2. Underlying immunodeficiency 3. Hemodynamic ally significant congenital heart disease 4. Chronic lung disease 5. Infants younger than 3 months Infants and children with non severe bronchiolitis usually can be managed in the outpatient setting Supportive care (maintenance of adequate hydration, relief of nasal congestion/obstruction, monitoring disease progression) and anticipatory guidance are the mainstays of management. The fluid intake and output of infants and children with bronchiolitis should be assessed regularly. Children with bronchiolitis may have difficulty maintaining adequate hydration because of increased needs (related to fever and tachypnea) and decreased intake (related to tachypnea and respiratory distress).
- 4. Respiratory support For infants and young children with bronchiolitis respiratory support is generally provided in a stepwise fashion. Most children require nasal suctioning. Supplemental oxygen is provided as necessary to maintain SpO2 >90 to 92 percent. Infants who are at risk for progression to respiratory failure often receive a trial of heated humidified high-flow nasal cannula (HFNC) therapy and/or continuous positive airway pressure (CPAP) before endotracheal intubation. However, initial endotracheal intubation is more appropriate than HFNC or CPAP for children with hemodynamic instability, intractable apnea, or loss of protective airway reflexes. Endotracheal intubation — Infants who have ongoing or worsening severe distress despite a trial of HFNC and/or CPAP, those who have hypoxemia despite oxygen supplementation, and those with apnea may require endotracheal intubation and mechanical ventilation. Signs of impending respiratory failure in infants and young children with bronchiolitis include marked retractions, decreased or absent breath sounds, fatigue, and poor responsiveness to stimulation (eg, weak or no cry). Arterial or venous blood gases obtained in infants with impending respiratory failure often reveal hypercapnia
- 5. Nasal suctioning — For children hospitalized with bronchiolitis, we suggest mechanical aspiration of the nares as necessary to relieve nasal obstruction. Saline nose drops and mechanical aspiration of nares may help to relieve partial upper airway obstruction in infants and young children with respiratory distress or feeding difficulties. • Are clinically stable • Are taking adequate oral fluids • Have maintained an oxygen saturation in air at the following levels for 4 hours, including a period of sleep: 1. over 90%, for children aged 6 weeks and over 2. over 92%, for babies under 6 weeks .