Patient will present as → a 5-month old infant with a three-day history of a mild respiratory track infection with serous nasal discharge, fever of 38.5 C, and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Flaring of the alae nasi, use of accessory muscles, and subcostal and intercostal retractions are noted. Expiratory wheezes and a cough are present.
Primarily an illness of young children, caused by RSV (respiratory syncytial virus)
Nasal washing for RSV, CX and AG assay
Indications for hospitalization include moderate tachypnea with feeding difficulties, visible retractions and oxygen desaturation
Supportive measures include, albuterol via nebulizer, antipyretics and humidified oxygen
|RSV, or respiratory syncytial virus, is a viral infection that infects upper airway epithelial cells, leading to copious secretions, coughing, sneezing and wheezing in patients. It primarily affects infants and young children with peak incidence between 2 to 7 months of age. It affects more male than female infants; occurs less frequently in breast-fed infants; and has a peak incidence during winter and spring. Most cases of bronchiolitis are caused by RSV.|
Antibiotics are utilized to treat bacterial, not viral, illnesses.
The use of corticosteroids in children with bronchiolitis has not been studied and does not appear to be helpful.
Racemic epinephrine is not indicated in the treatment of bronchiolitis.
pulse oximetry of 94% on room air
A pulse oximetry reading of 94% on room air is equivalent to a PaO2 of approximately 80 mm Hg which indicates the child is not in severe respiratory distress.
children between 4-6 months of age
Children less than 2 months of age require hospitalization.
moderate tachypnea with feeding difficulties
hyperinflation and interstitial infiltrates on chest x-ray
Hyperinflation and interstitial infiltrates on chest x-ray are frequently seen with acute bronchiolitis and by themselves are not an indication for hospitalization.
Corticosteroids are not indicated for the treatment of previously healthy infants with bronchiolitis.
Antibiotics are not indicated in the treatment of bronchiolitis unless there is a secondary bacterial infection.
Palivizumab is used only for prevention of RSV infection.