CCS Bronchiolitis -- hotobhaga,aiissman or anyone? - sriram

[ArchivalUser]

Friends,

Can anyone do the CCS case of Bronchiolitis in an infant? Please help me in figuring out the various steps to be ordered.

Thanks in advance!

-- Sriram

[ArchivalUser]

Please help me friends.........

[ArchivalUser]

ABC assesment and stabilization...
triage..admit in PICU if very severe, pre existing heart, lung or immune disease..
Trail of inhaled bronchodilators/corticosteroid
Tests: CBC and all...especially Xray and Test for RSV
Ribavirin...
there is also a monoclonal antibody..forgot the name
supportive: iv fluids, nutrition etc..
monitoring..
discharge with counselling..esp the incresed risk of ashtma, avoid indoor smoking etc.
RSV Ig before the next season(not sure)

[ArchivalUser]

Thanks Kuru!

This is according to USMLEWORLD........
Pulse ox
Patient examination

Admit to ward

IV access
Normal saline solution, Continuous
ABG,Stat
Cardiorespiratory monitering, Continuous(I dont know how to moniter respiratory system continuously. There is no option in the ccs software)
Puse ox,stat every 1hr
CXR stat
Humidified air,continuous
suction,Q1hr(nasal and poterior pharyngeal)
chest PT,Q2hrs
Epinephrine, Nebulisation, PRN
Albuterol Nebulisation, Q2-4hrs

Until this its given.
Now my doubt is
1) For albuterol........do we need to select continuous/one time bolus as there is no option for repeating the dose as needed.
2) How can we order any drug that can be given as PRN?
3)Can we give Ribavirin for any pt with bronchiolitis or only in certain cases?
4)How to order RSV Ag?
4)while discharging the patient, do we neeed to schedule a follow up visit and when?
6)What to be written for discharge instructions(Like as you said Avoid indoor smokingetc)

Sorry, I know this is a long list. But just wanna be sure in all these things for this case.

Thank you very much for posting your reply!
Sriram

[ArchivalUser]

hey..
admission location depends on the condition..if RR is like 80, pt is cyanosed etc. nopoint admitting in ward..
bronchodilators are prn...I dont know exactly how to write prn...unless the condition warrants admission, u give racemic epinephrine and observe for a couple of hours, if condition is improving discharge with instructions to parents about monitoring at home..
also because of severe tachypnoea, feeding is compromised so IV nutrition is important
Ribavirin is for severe cases/preexisting heart/lung diseases.
can schedule a follow up in one week.
i think PCR is diagnostic..not sure again

[ArchivalUser]

sriram, my strategy for prn drug was to give bolus dose and then give as needed as per pt. condition.
u can schedule follow up visit in 7- 10 days in this case.
i thing u can give ribavirin to all pt. i am not sure though u can check it from cmdt or some other reliable source.
i think ur case will end when u do the basic things as per uw so u dont have to worry about other things. believe me i was also worried same as u but if u do basic things initially in proprer sequence the case will end as early as 4- 5 min. so focus on basics and practice it on usmle cd.

[ArchivalUser]

contineous CR monitoring is the interval Hx/PE every 5 minutes with cardiac monitor in place

[ArchivalUser]

Thanks Kuru!

Yeah I know admission location varies with the situation.

For RSV there is an option ........Nasopharynx Respiratory syncitial virus Antigen(I typed Nasal washings and in the list I Found this).

For the reamaining I understood what you said.

Thanks,
Sriram

[ArchivalUser]

Hi Adrenaline_N, Thanks for your reply! Now I am a bit relieved with your words. As you said I will concentrate on the basics now.

Thanks again,
Sriram