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Bronchiolitis, croup


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Bronchiolitis, croup

  2. 2. Introduction Common disease of lower respiratory tract in infants Common age group: 1-3 months Common during winter
  3. 3. Etiology Viral RSV - >50% Para influenza 1,2,3 Adeno virus Non-viral Mycoplasma No bacterial etiology
  4. 4. Epidemiology 100,000-126,000 children <1 yr - hospitalized annually in the US because of RSV infection Males – non breast fed babies Older family members
  5. 5. Pathophysiology
  6. 6. Pathophysiology Bronchiolar obstruction Minor bronchial wall thickening Resistance α Air trapping & overinflation 1 radius4
  7. 7. Clinical features Happy wheezer Preceded by URTI, Mild to mod. fever(101-2°F) Gradual onset of wheezy cough, dyspnea Tachypnea interfere feeds, apnea in very young infants
  8. 8. Wheezy cough
  9. 9. Clinical features Physical examinations Tachypnea doesn’t correlate to the lung findings Increased work of breathing Hyperinflated chest Predominant wheeze Palpable liver & spleen
  10. 10. Bronchiolitis
  11. 11. Investigations Chest – X – Ray: Hyperinflated lungs with patchy atelectasis Flat diaphragm Increased peri-hilar bronchovascular markings
  12. 12. Investigations WBC count: Normal (without lymphopenia) Diagnosis: Healthy infant first time wheeze during winter
  13. 13. Differential diagnosis Bronchial asthma- family history atopy CCF- suck rest suck cycle FB aspiration- sudden onset, choking episode Bacterial pneumonia- sick child
  14. 14. Course & Prognosis Highest risk (cough & dyspnea) – first 48 to 72 hrs Death is due to Uncompensated respiratory acidosis Apnea Severe dehydration
  15. 15. Course & Prognosis Risk factors for severe disease- age <12 wk, preterm birth, or underlying comorbidity such as cardiovascular, pulmonary, neurologic, or immunologic disease
  16. 16. Treatment Hospitalize - hypoxia, inability to take oral feedings, apnea, extreme tachypnea Supportive therapy- IV fluids, humidified oxygen, careful monitoring
  17. 17. Treatment options available 1. Inhaled epinephrine: some clinical improvement 2. Inhaled bronchodilators – no use 3. Inhaled anti-cholinergics- no use 4. Hypertonic saline nebulization- some clinical improvement 5. Steroids- No role 6. Antibiotics – no role, Mycoplasma suspected- Macrolides 7. Antiviral- Palivizumab, Ribavirin-
  18. 18. Prevention Meticulous hand washing
  19. 19. STRIDOR AND ALTB Section 2
  20. 20. Stridor Harsh, high-pitched respiratory sound, which is usually inspiratory but can be biphasic- sign of upper airway obstruction
  21. 21. Causes  Acute Onset ALTB Epiglottitis Foreign body Retropharyngeal abscess Bacterial trachiitis Peritonsillar abscess  Chronic Vascular ring Laryngomalacia Vocal cord dysfunction
  22. 22. ALTB  Causes- Viruses- Parainfluenza virus 1,2,3 Inflammation of Larynx, trachea and bronchus
  23. 23. C/F  Upper respiratory tract infection- rhinorrhea, pharyngitis, mild cough, and low-grade fever for 1-3 days  Characteristic “barking” cough, hoarseness, and inspiratory stridor- worse at night and often recur with decreasing intensity for several days and resolve completely within a week  Agitation and crying- aggravate  Not ill looking
  24. 24. Croup
  25. 25. Investigations  X ray- Steeple sign Croup is a clinical diagnosis and does not require a radiograph of the neck
  26. 26. Steeple sign
  27. 27. Treatment Nebulized Adrenaline- moderate or severe croup- used as often as every 20 min Oral dexamethasone used a single dose of 0.6 mg/kg, a dose as low as 0.15 mg/kg may be just as effective Intramuscular dexamethasone and nebulized budesonide have an equivalent clinical effect
  28. 28. Complications  15% children with croup- complications  Hypoxia and low oxygen saturation only when complete airway obstruction imminent  Child who is hypoxic, cyanotic, pale, or obtunded- immediate airway management  Bacterial tracheitis in some
  29. 29. Epiglottitis Bends forward Tripod position Drooling Toxic child
  30. 30. Epiglottitis
  31. 31. Thumb sign
  32. 32. Croup vs epiglottitis  Inflammation of LTB- Caused by virus- Parainfluenza  Usually mild  No fever at presentation- non toxic child  X ray neck AP- Steeple sign  Treatment- Nebulized  Inflammation of epiuglottis- Caused by bacteria- H.influenzae  Serious illness  High fever at presentation- toxic child  X ray neck lateral- Thumb sign  Treatment- may need