bronchiolitis emt patient report

How common is bronchiolitis in the emergency room?

In patients under 2 years old, bronchiolitis accounts for almost 300,000 emergency room visits each year,​ of which as many as 40% result in hospitalization [2]. Currently, there is a large variation in the ED management of bronchiolitis leading to a large variation in practice.

Can a doctor order a chest Xray for bronchiolitis?

Clinicians should not routinely order laboratory and radiologic studies for diagnosis” The chest x-ray findings of bronchiolitis are often nonspecific, patchy infiltrates and hyperinflation that can often be mis-interpreted as consolidation and lead to inappropriate antibiotic use. Chest x-rays are often needlessly ordered for kids with wheeze.

How is the diagnosis of bronchiolitis made?

The diagnosis of bronchiolitis and assessment of disease severity should be based on history and physical examination. Laboratory and radiologic studies should not be routinely ordered for diagnosis.

Is continuous pulse oximetry indicated in the treatment of bronchiolitis?

Continuous pulse oximetry is optional for infants and children with bronchiolitis. Chest physiotherapy should notbe used in the management of bronchiolitis.

How do you assess bronchiolitis?

Your doctor may collect a sample of mucus from your child to test for the virus causing bronchiolitis. This is done using a swab that's gently inserted into the nose. Blood tests. Occasionally, blood tests might be used to check your child's white blood cell count.

Is bronchiolitis a medical emergency?

Bronchiolitis begins as a mild upper respiratory infection. Within 2 to 3 days, the child develops more breathing problems, including wheezing and a cough. Symptoms include: Bluish skin due to lack of oxygen (cyanosis) - emergency treatment is needed.

What are the typical signs and symptoms of a patient presenting with bronchiolitis?

Bronchiolitis starts out with symptoms similar to those of a common cold, but then progresses to coughing, wheezing and sometimes difficulty breathing. Symptoms of bronchiolitis can last for several days to weeks. Most children get better with care at home. A small percentage of children require hospitalization.

How do Emts treat respiratory emergencies?

Treatment: If a patient is in respiratory distress, treat immediately with high flow oxygen. Assist breathing with a bag-valve-mask (BVM) if the respiratory effort is insufficient as indicated by a slow rate and poor air exchange.

What breath sounds are heard with bronchiolitis?

Symptoms of Bronchiolitis Wheezing is a high-pitched purring or whistling sound. You can hear it best when your child is breathing out. Rapid breathing at a rate of over 40 breaths per minute.

What causes bronchiolitis?

Bronchiolitis is caused by a viral infection, usually the respiratory syncytial virus (RSV). RSV is very common and spreads easily in coughs and sneezes. Almost all children have had it by the time they're 2. In older children and adults, RSV may cause a cough or cold, but in young children it can cause bronchiolitis.

What are the nursing management of bronchiolitis?

Children who present with mild to moderate symptoms can be treated with interventions like nasal saline, antipyretics, and a cool-mist humidifier. Those children with severe symptoms of acute respiratory distress, signs of hypoxia, and/or dehydration should be admitted and monitored.

What are the nursing management of bronchitis?

Nursing Interventions: Encourage mobilization of secretion through ambulation, coughing, and deep breathing. Ensure adequate fluid intake to liquefy secretions and prevent dehydration caused by fever and tachypnea. Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery.

Which of the following is a clinical manifestation of bronchiolitis?

When symptoms of bronchiolitis first occur, they are usually similar to that of a common cold. Runny nose, fever, stuffy nose, loss of appetite and cough are the first signs of the infection. Symptoms may worsen after a few days and may include wheezing, shortness of breath, and worsening of the cough.

What should a nurse do when a patient is in respiratory distress?

Nursing ManagementManage nutrition.Treating the underlying cause or injury.Improve oxygenation with mechanical ventilation.Suction oral cavity.Give antibiotics.Deep venous thrombosis prophylaxis.Stress ulcer prophylaxis.Observe for barotrauma.More items...•

How do you assess a patient with respiratory distress?

Observe the patient for important respiratory clues:Check the rate of respiration.Look for abnormalities in the shape of the patient's chest.Ask about shortness of breath and watch for signs of labored breathing.Check the patient's pulse and blood pressure.Assess oxygen saturation.

What do you do in a respiratory emergency?

If someone is having breathing difficulty, call 911 or your local emergency number right away, then:Check the person's airway, breathing, and pulse. ... Loosen any tight clothing.Help the person use any prescribed medicine (such as an asthma inhaler or home oxygen).More items...•

How many infants respond to bronchodilators?

Approximately 15-25% of infants with bronchiolitis will respond to bronchodilators. If a trial of salbutamol is going to be attempted, the clinician should objectively assess the work of breathing before and after its administration and continue therapy only if a clinical benefit is noted.

How much apnea is associated with bronchiolitis?

The overall incidence of apnea in bronchiolitis is 2.7% but in those under 6 weeks of age, the risk can be as high as 5%. Risk factors that are associated with apnea in patients with Bronchiolitis include: Small for gestational age < 5 (2.3 kg) Age < 2 months. Oxygen saturations < 90%.

What is the AAP clinical practice guideline?

The American Association of Pediatricians (AAP) Clinical Practice Guideline for the Management and Diagnosis of Bronchiolitis6 states: “clinicians should diagnose bronchiolitis and assess disease severity on the basis of history and physical examination.

What is a EM case?

This EM Cases episode is on the diagnosis and management of Bronchiolitis. Bronchiolitis is one of the most common diagnoses we make in both general and pediatric EDs, and like many pediatric illnesses, there’s a wide spectrum of severity of illness as well as a huge variation in practice in treating these children. Bronchiolitis rarely requires any work up yet a lot of resources are used unnecessarily. We need to know when to worry about these kids, as most of them will improve with simple interventions and can be discharged home, while a few will require complex care. Sometimes it’s difficult to predict which kids will do well and which kids won’t. Not only is it difficult to predict the course of illness in some of these children but the evidence for different treatment modalities for Bronchiolitis is all over the place, and I for one, find it very confusing. Then there’s the sphincter tightening really sick kid in severe respiratory distress who’s tiring with altered LOC. We need to be confident in managing these kids with severe disease.

What is the only independent clinical predictor of an abnormal x-ray of the 9 variables studied?

The only independent clinical predictor of an abnormal x-ray of the 9 variables studied was the presence of fever. However, one should consider a chest x-ray when: the diagnosis is not clear. pneumonia is suspected due to focal lung findings. response to treatment is not as expected.

Can asthma cause wheezing?

Children with asthma usually presents with recurrent wheezing in a child >2 years old with a personal and/or family history of atopy or a family history of asthma. Environmental or allergic precipitants are often present in older children. Response to bronchodilators may help to differentiate bronchiolitis from asthma.

Can bronchodilators help with asthma?

Response to bronchodilators may help to differentiate bronchiolitis from asthma. Children with bacterial pneumonia often appear ‘toxic’ and tend to have higher grade fevers than those found in bronchiolitis. They may have focal chest findings and usually do not have wheeze.

The Who

The U.S. definition is for children less than two years of age, while the European committee includes infants less than one year of age.

The What

The classic clinical presentation of bronchiolitis starts just like any other upper respiratory tract infection: with nasal discharge and cough, for the first 1-2 days. Only about 1/3 of infants will have a low-grade fever, usually less than 39°C.

The Why

Respiratory syncytial virus is the culprit in up to 90% of cases of bronchiolitis. The reason RSV is so nasty is the immune response to the virus: it binds to epithelial cells, replicates, and the submucosa becomes edematous and hypersecretes mucus.

High-Risk Groups

Watch out especially for young infants, so those less than 3 months of age . Apnea may be the presenting symptom of RSV. Premature infants, especially those less than 32 weeks’ gestation are at high risk for deterioration. The critical time is 48 weeks post-conceptional age.

Guiding Principles

Neonates less than one month of age are at highest risk for apnea — they should be admitted.

The How

Below is a list of modalities, treatments, and the evidence and/or recommendations for or against:

Summary: The Good, the Bad, and the Ugly

Nasal suction and hydration are your best allies. You may elect to give a bronchodilator as a trial once and reexamine, if you’re a bronchodilating believer.

What is the most common pediatric condition in the first year of life?

Acute bronchiolitis is a common pediatric condition,affecting approximately 15% of infants in the firstyear of life. It is diagnosed clinically and presentswith wheezing, upper respiratory tract infectioussymptoms, and increased respiratory effort, typi-

Is bronchiolitis a common condition?

Acute bronchiolitis is a common condition , and acommon reason for emergency department visits forchildren under the age of two. However, managementof this condition can be highly variable, as no cleartreatment guidelines exist despite several well-designedtrials and meta-analyses having been performed. Fivemain management principles exist; however, there aremany treatment options.

What is the American Academy of Pediatrics' guideline for bronchiolitis?

The guideline, Diagnosis and Management of Bronchiolitis, was developed by the American Academy of Pediatrics and endorsed by the American Academy of Family Physicians. Key Recommendations. The diagnosis of bronchiolitis and assessment of disease severity should be based on history and physical examination.

When should palivizumab be administered?

Palivizumab prophylaxis should be administered during the first year of life to infants with hemodynamically significant heart disease or chronic lung disease of prematurity (<32 weeks gestation who require >21% O2for the first 28 days of life).

Can you give bronchodilators to children?

Bronchodilators (albuterol, salbutamol), epinephrine, and corticosteroids should notbe administered to infants and children with the diagnosis of bronchiolitis. Nebulized hypertonic saline should notbe administered to infants with the diagnosis of bronchiolitis in the emergency department.

How to prevent respiratory syncytial virus?

To prevent spread of respiratory syncytial virus (RSV), hands should be decontaminated before and after direct contact with patients, after contact with inanimate objects in vicinity of patient, and after removing gloves. Alcohol rubs are the preferred method for hand decontamination.

Can you take antibiotics with bronchiolitis?

Antibiotics should notbe used in children with bronchiolitis unless there is a concomitant bacterial infection. Supplemental oxygen is not necessary in children and infants with a diagnosis of bronchiolitis if SpO2exceeds 90%. Continuous pulse oximetry is optional for infants and children with bronchiolitis.

What is the condition of a baby?

Bronchiolitis. Bronchiolitis is an infection of the small airways of the lung (the bronchioles). It is a common condition of babies. Most affected babies are not seriously ill and make a full recovery. Sometimes it becomes more serious and hospital care may be needed.

What is the cause of bronchiolitis?

Bronchiolitis means inflammation of the bronchioles. It is usually caused by a virus called the respiratory syncytial virus (RSV). Other viruses are sometimes the cause. RSV is a common cause of colds. In some babies RSV can also infect lower down the airways to cause bronchiolitis.

What is the purpose of monthly antibody injections?

Antibody injections. Monthly antibody injections from birth may help to limit the severity of bronchiolitis if it should occur. This may be considered for babies who are very premature, or who have severe chest or heart conditions. The aim is to limit the severity of bronchiolitis if it occurs.

Why do breastfed babies have antibodies?

This is compared to non-breastfed babies and those who live with smokers. This is because 'passive smoking' by a baby affects the lining of the airways, causing less resistance to infection. Also, breastfed babies receive antibodies that are transferred from their mother which may be protective.

Why do babies go to hospital with bronchiolitis?

For most it is a short stay until they are over the worst of it. The main reason for hospital admission is concern over poor drinking or feeding. In hospital a baby can be fed by a tube passed into the stomach if necessary.

How long does it take for a cough to go away?

After peaking, symptoms then usually gradually ease and go within 1-2 weeks. An irritating cough can linger a bit longer.

How does air travel through the lungs?

Understanding the lungs. Air travels into the lungs via the windpipe (trachea), down larger branching airways (bronchi) and into the smaller airways (bronchioles). The bronchioles are the smallest airways before the air enters the millions of tiny air sacs (alveoli) of the lung. Oxygen from the air passes into the bloodstream through ...

What is the most common cause of bronchiolitis?

Bronchiolitis is a common pediatric illness often found in children younger than 2 years old [1]. It is most commonly caused by respiratory syncytial virus (RSV), but can be caused by other viruses, including adenovirus, human metapneumovirus, influenza and parainfluenza [1].

What is the disease that causes rhonchi and cough?

Bronchiolitis often is the sequela of a viral inflammation of the epithelial lining of the bronchioles, causing inflammation, wheezing, increased mucus production, rhonchi and subsequent necrosis of those epithelial cells [2]. Initial presentation of the disease is often viral in nature, presenting with nasal congestion, runny nose and cough.

What is a tachynea?

Tachypnea, accessory muscle usage and retractions are subsequent symptoms of the illness, progressing to respiratory failure in severe cases. In infants, respiratory failure can be recognized with cyanosis, hypoxia, nasal flaring and grunting. Frequently, bronchiolitis is a clinical diagnosis that is made after completing a thorough history ...

How many emergency room visits are there for bronchiolitis?

Adjunct testing, including lab work and imaging, is often not required. In patients under 2 years old, bronchiolitis accounts for almost 300,000 emergency room visits each year,​ of which as many as 40% result in hospitalization [2].

What is the best treatment for asthma?

Treatment for asthma should almost always include oxygen supplementation, especially for those presenting with hypoxemia, or moderate to severe exacerbation. In addition to oxygen, short-acting beta agonists, such as albuterol, are the mainstay of treatment.

What is supportive care for bronchiolitis?

Supportive care is the mainstay of treatment in bronchiolitis, ranging from anything the patient needs [1]. Initially, the patient will likely require nasal suctioning, analyzing pulse oximetry and oxygen administration. If this initial set of interventions is not sufficient, additional escalation may be required, including but not limited to positive pressure ventilation and endotracheal intubation. The most recent guidelines published by the American Academy of Pediatrics (AAP) in 2018 only recommend parenteral fluids in patients who are unable to adequately tolerate oral rehydration.

Can asthma be exacerbated in pediatrics?

Pediatric asthma treatment options. It should be noted that patients with any degree of asthma severity can have any degree of asthma exacerbation. Even those who are diagnosed with mild intermittent asthma can present with the most severe exacerbation [3].

What are the goals of bronchiolitis care?

Nursing care planning goals for a child with bronchiolitis include maintenance of effective airway clearance, improved breathing pattern, relief of anxiety and fatigue, increased parental knowledge about the disease condition, and absence of complications.

What is the inflammatory process that causes a reduction in expiration, air trapping, and hyperinflation

Bronchiolitis is an acute viral inflammation of the lower respiratory tract involving the bronchioles and alveoli. Accumulated thick mucus, exudate, and cellular debris and the mucosal edema from the inflammatory process obstruct the smaller airways (bronchioles). This causes a reduction in expiration, air trapping, and hyperinflation of the alveoli. The obstruction interferes with gas exchange, and in severe cases causes hypoxemia and hypercapnia, which can lead to respiratory acidosis. Children in a debilitated state who experience this disorder with other serious diseases are hospitalized.

What is the first priority for a patent airway?

Maintaining patent airway is always the first priority, especially in cases like trauma, acute neurological decompensation, or cardiac arrest. Assess respirations. Note quality, rate, pattern, depth, flaring of nostrils, dyspnea on exertion, evidence of splinting, use of accessory muscles, and position for breathing.

How to help a child with postural drainage?

Assist to perform deep breathing and coughing exercises in child when in a relaxed position for postural drainage unless procedures are contraindicated; use incentive spirometer in older child, blowing up balloon, blowing bubbles, blowing a pinwheel or blowing cotton balls across the table in younger child.

What happens when you have an obstruction in your alveoli?

The obstruction interferes with gas exchange, and in severe cases causes hypoxemia and hypercapnia, which can lead to respiratory acidosis.

How often should you assess respiratory status?

Assess respiratory status, a minimum of every 2–4 hours or more often as indicated for a decreasing respiratory rate and episodes of apnea. Changes in breathing pattern may occur quickly as the child’s energy reserves are depleted. Assessment and monitoring baseline reveal rate and quality of air exchange.

How to teach parents about the virus?

Encourages parents to seek prompt medical attention, as needed. Teach of potential for spread of the virus. to other family members and need for segregation of infant/small child from others. Explains that virus is easily transmitted, with an incidence as high as half of the family members acquiring viral infections.