a 4 year 2 month old girl with recurrent brontheolitis 小兒科個案報告 氣喘

1. Pediatric case meeting
Reporter. 林宜慧
Resident. 施佳宏醫師
Supervisor. 劉萬雄主任

2. Case Data
Name: 葉 0 妍
Chart no.: 30015136
Age: 4Y2M
Sex: Female

3. History of recurrent bronchiolities
Cough, rhinorrhea, nasal stiffness
with mild fever for 2 days → OPD
Medicon-A + Nasco + Guaifenesin
0912
0914 night Short of breath
0915 9am → ED
Shortness of breath
Consious mild drowsy
Wheezing breathing sound, bil
Chest wall restraction
Ventri mask 50% - SpO2 88-92%
0915 10am
→ PICU

4. Lab+Image(09/15)
Peribronchial thickeningsover
bothlungs,
suspect inflammatory process
andemphysematouschangeof bothlungs.

5. Past history
●
(Born at 2013-03 at 本院 )
● Ostium secundum type atrial septal defect
diagnosed 2014-10 with OPD f/u
● Recurrent bronchitis and bronchopneumonia
since 2016-03 間隔 2m 到 2w
● Bilateral inguinal hernia s/p bilateral
herniorrhaphy in 2016-09

6. Personal history
● Birth History: GA:39 weeks, BBW:2640gm,
G1P1, NSD, 本院
● Vaccination Hx: as schedule (except self-paid
Rotavirus and Influenza vaccine)
● Growth & Development: as milestone

7. 0915 PI CU: imp-Acutebronchiolitis
or asthmaticbronchiolitis
.SaO2 90-100% under O2 tent 10L/minuse
.Methylprednisolone16mg q6hivp
.Aminophylline250mg q6hivd
.Atrovent 2ml+ bricanyl 2ml q4hinh
Ward:
.SaO2 90-100% under O2 tent 10L/minuse
.Methylprednisolone16mg q6hivp
.Aminophylline250mg q6hivd
.Atrovent 2ml+ bricanyl 2ml q4hinh
0916
WBC CRP
23.6 0.7
WBC CRP
17.6 0.2
0917
.SaO2 97-100% under O2 tent 10L/min use
.Methylprednisolone16mg q6h->q8hivp
.Aminophylline250mg q6h->q12hivd
.Atrovent 2ml+ bricanyl 2ml q4hinh
0920
Myco(-)
Chla (-)

8. WBC CRP
16.9 0.2
0923
Coughwithsputum+ persisted leukocytosis
--> added ampicillin
0922
Discharge
AcetylCYSTEINE(200mg/3g) 顆粒 [0.4 PK QID 重 PO]
Dimethicone (40mg) 錠 . [0.8 TB QID 磨 PO]
Prednisolone (5mg) 錠 [2 TB BID 磨 PO]
Bromhexine(2mg/ml,50ml)Sol'n [2 ML QID INHL]
Amoxicillin(250mg) 膠囊 . [0.8 CP QID 磨 PO]
O2 tent Methylp Aminophy A+B
partial 10mg q8h 250mg qd 2ml q4h
DC 10mg q12 160mg qd 2ml q4h
DC DC DC 2ml q4h
0921
0920

10. Final diagnosis
Asthmaticbronchiolitis