NICE Bronchiolitis


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Author: Chris Connolly / Codes: CC21, CC3, CC5, PAP5, RP5, SLO1, SLO10, SLO2, SLO5 / Published: 21/10/2015

Here’s my review of the latest (June 2015) on the diagnosis and management of bronchiolitis.

First up some revision: When is it Bronchiolitis?
Characterised by a coryzal illness for a few days beforehand and then a combination of
1: persistent cough
2: Tachypnoea and or chest recession
3: Wheeze or crackles or both.

It is usually in the first year of life with a peak during age 3-6 months.
When you assess your patient you need to take a good focussed history, make a thorough examination focussing on evidence of respiratory failure/distress and make an assessment to the hydration status of the child, whilst thinking about and taking steps to discount other diagnoses such as pneumonia and Viral Wheeze.

Treatments are supportive: Fluid (oral/NG/IV in that order) and oxygen.
There is no place for any other medications as a routine, and no place for tests such as CXR or venous bloods to aid the diagnosis.

If discharging you patient ensure the parents are happy with ‘red flags’
1: worsening work of breathing
2: Reduced (significantly) fluid intake or no wet nappy for 12 hours
3: Episodes of apnoea or cyanosis
4: how to detect exhaustion.

I think this is a useful set of guidelines from the folks over at NICE HQ as it provides us with some clear criteria for admission, discharge, red flag highlighting for parents and also provides a great summary of evidence with regards the lack of benefit to additional medical therapies.

Thanks for listening and reading. Let me know what you think!
Chris C
Full guideline

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