Infants in respiratory distress
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:
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mild fever
wheezing
coughing
able to fulfill meals with short breaks
• No previous history of bronchial obstruction or atopy
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Examination
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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
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?
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Acute viral bronchiolitis
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)
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
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
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
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Imaging
• Chest x-ray
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
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Treatment
• Inhalations?
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Saline
Racemic adrenaline (epinephrine)
Salbutamol?
Hypertonic saline?
• Corticosteroids?
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
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)
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Lab
• CRP 7, pCO2 6,5
• Admit to hospital?
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat