q13: bronchiolitis simon craig. 3 parts table – clinical severity list of risk factors for severe...

Q13: Bronchiolitis

Simon Craig

3 parts

• Table – clinical severity

• List of risk factors for severe complications

• Indications for a chest x-ray

Clinical severity assessment

• 12 marks

• 6 marks for the various clinical factors

• 6 marks for sensible delineation of mild / moderate / severe

Clinical severity assessment

• Clinical factors• Behaviour• Respiratory rate• Accessory muscle use• Feeding• Oxygen• Apnoeic episodes

• NOT• Speech• Wheeze• Crepitations• Cough• Stridor

Risk factors for severe disease

• 6 marks• Young (<6 weeks)• Ex-premature infants• Congenital heart disease• Neurologic conditions• Chronic respiratory illness• Pulmonary hypertension

• Indigenous • Delayed presentation• Failure to thrive / LBW

• NOT• Immunisation status• Diabetes• Smokers at home• <6 months• Sepsis• Dehydration• Pneumothorax• Sats <92% despite

oxygen

Chest x-ray

• 2 marks• Severe illness, eg

CPAP or intubation• Localised signs on

auscultation• Murmer with signs of

congestive cardiac failure

• NOT• Fever• Low saturations• Septic, eg temp >40• SBP <80

• ?inhaled foreign body

Pass mark?

• 12 / 20

Questions?

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