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1/ RSV season is upon us so let's review the 2014 AAP guidelines on bronchiolitis! But first, a curiosity question - do you think the hospitalization rates for bronchiolitis will decrease this year in light of social distancing and masking guidelines?
2/ We know that RSV is the leading viral cause of bronchiolitis. But what is the next most common viral culprit?
3/ Hm..the pores of what??? Babies' lungs don't have the ability to participate in collateral ventilation so V/Q mismatch & inadequate ventilation of obstructed alveoli is common in young infants with bronchiolitis. Perhaps why kids <2 years fare worse than their older friends?
4/ Chances are, your little patients are bound to get RSV in their lifetime! Note that bronchiolitis season varies by region. Who knows what this year might look like!
5/ The diagnosis of bronchiolitis can be made solely on the basis of?
6/ AAP guidelines recommend that the diagnosis of bronchiolitis be on the basis of history and physical exam - no need for CXR or labs. Be sure to assess risk factors as well!
7/ Skip the albuterol, epinephrine, and steroids! The 2006 AAP guidelines suggested clinicians could trial albuterol as an option, but note that it is no longer indicated
8/ What about 3% hypertonic saline?
9/ Did you know that at baseline healthy infants can have transient desats with no long-term sequelae and are completely normal? Be sure to discuss this on rounds next time!
10/ Skip the chest physiotherapy. And perhaps frequent deep suctioning too.
11/ No need for antibiotics unless there is a strong suspicion for bacterial infection!
12/ A common reason for hospitalization for children with bronchiolitis is not only respiratory distress but also dehydration. Ever wondered whether NG or IV fluids were more popular? Both had equivalent parental satisfaction scores and are great options!
13/ Now bringing it all together
