Infants in respiratory distress

transcript

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat

Case 1: 6 months old boy

• 1 week cold, general condition OK then• 1,5 day:

– mild fever– wheezing– coughing– able to fulfill meals with short breaks

• No previous history of bronchial obstruction or atopy

Examination

• Unhappy, resists examination• Coughing attacks during consultation• Retractions intercostal and subcostal• RR 45, HF 130, T 38,5, SaO2 95%• Auscultation: moderate crepitations, some expiratory

wheeze• Skin turgor, capillary refill 1-2 sec, mucous

membrane wet

• CRP 30• pH 7.30, pCO2 5,0

• Diagnosis?• Admit to hospital?• Other solutions?

Acute viral bronchiolitis

History

• Wheezing, degree of respiratory distress• Duration of symptoms, developing from common

cold?• Eating: able to complete meals?• Urine output• 2 year older sibling in kindergarden• (atopic excema, previous BO, family history)

Clinical examination

• Retractions– Jugular, Intercostal, Subcostal

• Respiratory frequence• Conciousness/general appearance• Auscaltation

– Fine crepitations– Prolonged expirium– Expiratory wheeze

• SaO2• Nasal flaring

Clinical examination

• Hydration level– (skin turgor, capillary refill, mucus membrane, fontanel)

• Heart rate

Laboratory investigations

• Blood gases – pH, pCO2• Dehydration assessment

– bicarbonate, urea, BE• Na, K, Hb, WBC, glukose, kreatinin

Imaging

• Chest x-ray

Treatment

• Oksygen• Nutrition

– Nasogastric tube• Intravenous fluid• Respiratory support

– CPAP– Conventional respirator

• Nasal spray

Treatment

• Inhalations?– Saline– Racemic adrenaline (epinephrine)– Salbutamol?– Hypertonic saline?

• Corticosteroids?

Case 2: 4 weeks old girl

• 2 year old brother in kindergarden with a cold last week

• Upper airway infection 3 days• Much coughing last 24 hours• 2 apnoes of 10 seconds each last 12 hours• eats OK, but must have some breaks

Examination

• Smiles, excellent contact. Good activity• Mild subcostal retractions• Auscultation: some fine crepitations, no ekspiratory

wheezing or prolonged expirium• HR 140, RF 55• (Capillary refill time 2 sec, mucus membranes wet,

turgor OK)

• CRP 7, pCO2 6,5

• Admit to hospital?

Infants in respiratory distress

Documents