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Infants in respiratory distress

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

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Infants in respiratory distress

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  1. Infants in respiratory distress

  2. 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

  3. Examination • Unhappy, resistsexamination • Coughingattacks during consultation • Retractionsintercostal 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

  4. Lab • CRP 30 • pH 7.30, pCO2 5,0 • Diagnosis? • Admit to hospital? • Othersolutions?

  5. Acute viral bronchiolitis

  6. History • Wheezing, degreeofrespiratorydistress • 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)

  7. Clinical examination • Retractions • Jugular, Intercostal, Subcostal • Respiratoryfrequence • Conciousness/generalappearance • Auscaltation • Fine crepitations • Prolongedexpirium • Expiratorywheeze • SaO2 • Nasal flaring

  8. Clinical examination • Hydrationlevel • (skin turgor, capillary refill, mucus membrane, fontanel) • Heart rate

  9. Laboratoryinvestigations • Blood gases – pH, pCO2 • Dehydration assessment • bicarbonate, urea, BE • Na, K, Hb, WBC, glukose, kreatinin

  10. Imaging • Chestx-ray

  11. Treatment • Oksygen • Nutrition • Nasogastric tube • Intravenous fluid • Respiratory support • CPAP • Conventional respirator • Nasal spray

  12. Treatment • Inhalations? • Saline • Racemicadrenaline (epinephrine) • Salbutamol? • Hypertonic saline? • Corticosteroids?

  13. Case 2: 4 weeks old girl • 2 year old brother in kindergarden with a cold last week • Upperairwayinfection 3 days • Muchcoughing last 24 hours • 2 apnoes of 10 seconds each last 12 hours • eats OK, but must have some breaks

  14. Examination • Smiles, excellentcontact. Goodactivity • Mild subcostalretractions • Auscultation: some fine crepitations, no ekspiratory wheezing or prolonged expirium • HR 140, RF 55 • (Capillary refill time 2 sec, mucus membranes wet, turgor OK)

  15. Lab • CRP 7, pCO2 6,5 • Admit to hospital?

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