infants in respiratory distress
DESCRIPTION
Infants in respiratory distress. 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 - PowerPoint PPT PresentationTRANSCRIPT
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Infants in respiratory distress
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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
![Page 3: Infants in respiratory distress](https://reader036.vdocuments.net/reader036/viewer/2022062315/56816014550346895dcf15d3/html5/thumbnails/3.jpg)
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
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
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Lab
• CRP 30• pH 7.30, pCO2 5,0
• Diagnosis?• Admit to hospital?• Other solutions?
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Acute viral bronchiolitis
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
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)
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Clinical examination
• Retractions– Jugular, Intercostal, Subcostal
• Respiratory frequence• Conciousness/general appearance• Auscaltation
– Fine crepitations– Prolonged expirium– Expiratory wheeze
• SaO2• Nasal flaring
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Clinical examination
• Hydration level– (skin turgor, capillary refill, mucus membrane, fontanel)
• Heart rate
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Laboratory investigations
• Blood gases – pH, pCO2• Dehydration assessment
– bicarbonate, urea, BE• Na, K, Hb, WBC, glukose, kreatinin
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Imaging
• Chest x-ray
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Treatment
• Oksygen• Nutrition
– Nasogastric tube• Intravenous fluid• Respiratory support
– CPAP– Conventional respirator
• Nasal spray
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Treatment
• Inhalations?– Saline– Racemic adrenaline (epinephrine)– Salbutamol?– Hypertonic saline?
• Corticosteroids?
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
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
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
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)
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Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Lab
• CRP 7, pCO2 6,5
• Admit to hospital?