Bronchio-what?
The diagnosis of bronchiolitis is based on the following:
History
Physical examination
Children with bronchiolitis may become clinically worse at what day of illness?
Classically day 3-4 of illness
These are the most common bacterial causes of acute otitis media (name 2 or more)
Streptococcus pneumoniae
Streptococcus progenies (GAS)
Haemophilus influenzae
Moraxella catarrhalis
Children with otalgia may have this diagnosis and NOT acute otitis media
Acute otitis externa
These viruses are the most common causes of bronchiolitis in children < 2 yo (name 4)
Respiratory syncytial virus
Rhinovirus
Human metapneumovirus
Parainfluenza virus
Adenovirus
Influenza
Children with bronchiolitis are best managed/ treated with (name 4)
Supportive care!
Rest
Help with fluids (IV vs NG)
Oxygen
Gentle nasal suctioning (evidence is equivocal)
These symptoms may suggest the diagnosis of acute otitis media (name 3)
Difficulty sleeping
Decreased playfulness
Irritability
Fever
Ear tugging/ ear pain
Over the past decades, rates of acute otitis media have decreased significantly because of:
Immunizations!
Specifically, routine use of the pneumococcal vaccination
Children with bronchiolitis may have these features on physical examination (name 4)
Tachypnea
Work of breathing: subcostal/ intercostal muscle use, nasal flaring
Apnea
Wheezing and/or crackles
Low O2 saturation
These are the criteria for discharging children with bronchiolitis from hospital (name at least 3)
Tachypnea and work of breathing better
O2 saturations > 90% without supplemental O2
Adequate oral feeding
Education provided, appropriate follow up arranged
These features on history and physical exam are required to diagnose acute otitis media:
Acute onset of otalgia
Middle ear effusion PLUS inflammation of middle ear (bulging, erythematous, yellow/ cloudy TM, perforated TM)
Mildly ill children with acute otitis media may be managed differently than severely ill children. This is how we manage mildly ill children:
Observe and reassess in 24-48 hours
If not improved or worsening, treat with antibiotics
These should be included in the differential diagnosis for wheezing in children < 2 years old (name 5)
Asthma
Bronchiolitis
Laryngotracheomalacia
Foreign body aspiration
Congestive heart failure
Vascular ring
Allergic reaction
Cystic fibrosis
Mediastinal mass
Tracheoesophageal fistula
Gastroesophageal reflux
These are indications to admit a child with bronchiolitis to hospital (name 5)
Severe resp distress
Supplemental O2 required to keep SpO2 > 90%
Dehydration/ poor fluid intake
Cyanosis/ history of apnea
High risk for severe disease
Family unable to cope
These are risk factors for acute otitis media (name 4 or more)
Young age
Frequent contact with other children
Orofacial abnormalities
Household crowing
Exposure to cigarette smoke
Pacifier use
Shorter duration of breastfeeding
Family history of AOM
Prolonged bottle feeding while lying down
These are indications to start immediate antibiotic treatment for children with acute otitis media (name at least 3)
Perforated TM
Bulging TM with moderate-severe systemic illness
Severe otalgia
Ill for 48 hrs or more
These investigations should be done in all children with bronchiolitis
None!
No role for routine CXR, nasopharyngeal swab, CBC, blood gas, or bacterial cultures
These groups are at higher risk for severe bronchiolitis
Infants born premature (< 35 weeks)
< 3 months old at presentation
Hemodynamically significant cardiopulmonary disease
Immunodeficiency
These are potential complications of acute otitis media (name 3 or more)
Mastoiditis
Acute facial nerve or sixth nerve palsies
Labyrinthitis
Venous sinus thrombosis
Meningitis
Children 6 months to 2 years old are treated with _____ for ____ days compared to children over 2 years of age are treated with _____ for ____ days.
Bonus 100 points if you know the dose
6 months - 2 years: Amoxicillin, 10 days
Over 2 years: Amoxicillin, 5 days