cronchiolotis emt patient report

What's new in bronchiolitis clinical care and research?

Much of the emphasis of the last few decades of bronchiolitis clinical care and research has centered on the identification and testing of novel therapies. Future quality improvement efforts should focus more on the limitation of unnecessary testing and treatments.

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.

Could blocking chemokines lead to new treatments for bronchiolitis?

It is hoped that blocking specific chemokines, or more likely their receptors, may lead to new treatments A major player in the acute and chronic symptoms of bronchiolitis is perhaps the non-adrenergic, non-cholinergic airway nervous system, with involvement of neurokinins; this too may open up new avenues of treatment

When should chest physiotherapy not be used in the management of bronchiolitis?

Chest physiotherapy should notbe used in the management of bronchiolitis. 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).

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.

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

Typical manifestations include fever, tachypnea, retractions, wheezing, and cough. Clinical evaluation is usually adequate for diagnosis, but more severely ill children should have pulse oximetry, chest x-ray, and rapid antigen testing for RSV.

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.

How do you manage bronchiolitis?

Providing oxygen (typically by nasal cannula) is standard care for bronchiolitis. Newly-developed medical devices can now deliver high-flow humidified oxygen that is thought to provide more comfortable and effective delivery of gases while retaining airway humidity.

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.

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's the difference between bronchitis and bronchiolitis?

Both can be caused by a virus. Both affect the airways in the lungs, but bronchitis affects the larger airways (the bronchi). Bronchiolitis affects the smaller airways (bronchioles). Bronchitis usually affects older children and adults, while bronchiolitis is more common in younger children.

How do you prevent bronchiolitis?

What can I do to prevent bronchiolitis?keeping away from other people (adults and other children) who have a cough or a cold – this is common sense, but not always possible.making sure you, your family and anyone who handles your baby washes their hands regularly - you should also regularly wash your child's hands.More items...

What topics should be included in discharge instructions after hospitalization with bronchiolitis?

Home careMake sure your child drinks plenty of fluids to prevent dehydration. ... Try keeping your child's head raised (elevated) to make it easier to breathe. ... Use a rubber suction bulb to remove mucus from your child's nose. ... Clean your hands with alcohol-based hand cleaner before and after touching your child.More items...

Does nebulizer help with bronchiolitis?

Because bronchiolitis is usually caused by a virus, drug treatment is usually not effective. Hypertonic saline (sterile salt water solution) breathed in as a fine mist using a nebuliser may help relieve wheezing and breathing difficulty.

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.

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.

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 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.

Does hypertonic saline help with airway edema?

Hypertonic saline is theorized to be of benefit based on its ability to reduce airway edema and mucous plugging. While nebulized hypertonic saline has been found to reduce length of stay and severity scores in hospitalized patients in a Cochrane review in 2013, the benefits of this treatment are short term and have not been consistently found to reduce rates of admissions or improve oxygenation. Our experts view this treatment as a temporizing measure for a patient who is going to be admitted and not as a rescue maneuver. Once again, the CPS guidelines are equivocal with respect to nebulized hypertonic saline in bronchiolitis.

Can bronchiolitis be interpreted as consolidation?

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.

Is RSV testing good for bronchiolitis?

In an otherwise healthy child who presents typically with Bronchiolitis, RSV testing is likely of no value because bronchiolitis is a clinical diagnosis, and the results of the test will not alter management.

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 least ineffective bronchodilator?

The least ineffective bronchodilator is nebulised adrenaline (epinephrine).12Adrenaline, anticholinergics, and β2 agonists are not recommended as routine treatments.2.

Is chest radiography useful?

Specifically, chest radiography is not useful8and anecdotally may lead to the unnecessary prescription of antibiotic s. C reactive protein is not a useful test to diagnose bacterial infection in this context,10and urea and electrolytes need only be measured if the infant is clinically dehydrated.7.

Is bronchiolitis toxic to infants?

In young infants, particularly if born preterm, episodes of apnoea may be the first presentation of bronchiolitis.7The infant is rarely systemically toxic (drowsy, lethargic, irritable, pale, mottled, and tachycardic)—this feature should prompt a search for another diagnosis.

Is intensive care needed in the acute phase?

In summary, no treatment is effective in the acute phase, and no treatment in the acute phase has the least effect on the prevalence or severity of long term symptoms. Indications that intensive care is needed. Rarely, a child may deteriorate in hospital, such that high dependency or intensive care is required.

Is bronchiolitis a seasonal disease?

Summary points . • Bronchiolitis caused by respiratory syncytial virus is an important and seasonal cause of respiratory morbidity in the first year of life. • No effective preventive or therapeutic strategies exist, and supportive management is offered.

When does bronchiolitis start in the UK?

Bronchiolitis in the UK usually occurs in the winter months (November to March). Cold symptoms: a runny nose, cough and mild high temperature (fever) are usual for the first 2-3 days. Fast breathing, difficulty with breathing and wheezing may develop as the infection travels down to the bronchioles.

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.

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.

Is bronchiolitis a serious illness?

For most it is not a serious illness. However, about 3 in 100 babies are admitted to hospital with bronchiolitis before they are 1 year old. Babies at higher risk of developing a more serious illness with bronchiolitis include: Premature babies. Babies with heart conditions.

What Is a Patient Care Report?

We often hear of care reports based on by medical teams or by medical authorities. Yet, we are not sure how this differs from the kind of report that is given to us by the same people. So this is the time to make it as clear as possible.

How to Write a Patient Care Report?

Where do you even begin when you write a patient care report? A lot of EMS or EMTs do know how to write one since they are trained to do so.

What is a patient care report?

A patient care report is a document made mostly by the EMS or EMTs. This documented report is done after getting the call. This consists of the information necessary for the assessment and evaluation of a patient’s care.

What should not be written in a patient care report?

What should be avoided in a patient care report is making up the information that is not true to the patient. This is why you have to be very careful and very meticulous when writing these kinds of reports. Every detail counts.

Who is in charge of reading the patient care report?

The person or the people who will be reading the report are mostly medical authorities. When you are going to be passing this kind of report, make sure that you have all the information correctly. One wrong information can cause a lot of issues and problems.

What Should Be Included In A Patient Report?

Several elements should be included in the format including background information, medical history, physical examination, specimens obtained, and treatment given.

What Is Emt Report?

EMT is an EMT specialization. A 15 minute read. Prehospital medical care reports or PCR (also electronically recorded pPCR) provide detailed records of individual patient contact, treatment, transportation, and cancellation throughout each EMS service’s territory.

What Is A Writing Pcr?

Page 1. Students writing from 3-11 will use three PCR items to measure their written composition in the PARCC Summative Assessments. Whether it’s informal or formal, writing in a classroom can take a range of forms.

Overview

Symptoms

• For the first few days, the signs and symptoms of bronchiolitis are similar to those of a cold: 1. Runny nose 2. Stuffy nose 3. Cough 4. Slight fever (not always present) After this, there may be a week or more of difficulty breathing or a whistling noise when the child breathes out (wheezing). Many infants also have an ear infection (otitis media)...

See more on mayoclinic.org

Causes

Risk Factors

Complications

Prevention