Tuesday, April 2, 2013


Development of total obstruction of respiratory tracts lies in basis of syndrome, which is  conditioned with the expressed hypersecretion of phlegma, with the edema and swelling of mucus of  bronchial tubes and bronchiols and, in a less measure, bronchospasm in  the children of the first year of life on a background of viral, more frequent respiratory-syncitial infections.

Criteria of diagnosis of bronchiolitis:
1. Presence of the catarrhal phenomena (rhynopharyngitis, cough).
2. Temperature of body – subfebrile, rarely 38oС.
3. Expressed signs of respiratory insufficiency:  shortness of breathing, blowing nostrils, cyanosis of nasolabial triangle, participation of auxiliary musculature.
4. Violation of the bronchial passage: thorax is emphysematosis; horizontal position of ribs, flat position of diaphragm.
5.Bandbox sound at percussion.
6. Auscultation: hard  breathing  with prolonged inspiration, moist wheezes, on outbreathing - dry, whistling.
7. Cardiovascular syndrome – tachycardia, weakening of tones.
8. X-ray- sharp swelling of lungs tissue, increased broncho-vascular pattern, without infiltrative shades; sometimes atelectasis.

Clinic. Syndrome of airway obstruction lies at the basis of acute bronchiolitis, which is more typical for children of the first six months of life. In acute bronchiolitis body temperature is subfebrile or normal, respiratory failure progresses gradually. Signs of intoxication are insignificant. Characteristic features are perioral or acrocyanosis, dry cough, a large number of small moist rales on both sides - "wet" lung and a small number of dry wheezes.  
In severe cases dyspnea has predominantly expiratory character, groaning breath, tension and swelling of nostrils, participation in the act of breathing supporting muscles, general cyanosis of the skin. Nonproductive cough, frequently emphysematous swelling of the chest are present. Above the lungs percussion sounds are bandbox, throughout the lungs a large number of small bubbling and wet crepitative wheezing. There are tachycardia, increased liver,  may be attacks of apnea, hypoxic seizures, dehydration.
X-ray examination shows the symmetric strengthening of pulmonary pattern of  both sides, increase of transparency of pulmonary tissue, absence of infiltratative shades. In the blood test the appropriate changes are absent.

Help on prehospital stage.
1.             To release from clothes.
2.             To give the promoted position of body to the child.
3.             By a rubber bulb or gauze clean the  nasal cavity, mouth and pharynx
                     from mucus and phlegma.
4.             To provide access of fresh air.
5.             Oxygenation with clean moistened oxygen through a mask.
6.             Euphyllini in dose of 3-5 mg/kg of mass -24 % solution intramuscular.
7.             3 % solution of Prednisoloni 1-2 mg/kg of  the masses  for 
                     dose intramuscular
8.             Salt-alkaline inhalation.
9.             Urgent hospitalization.

Help on  hospital stage.
1.             To release respiratory tracts from mucus and phlegma with the help
                       of electrosuccer.

2.             Oxygentherapy with  moistened warm 40 %  oxygen through a nasal
                    catheter or mask 3-5 litres per 1 minute.
3.             Inhalation of broncholytic mixture: Euphillini – 0,3, ephedrine – 0,2,
                     novocaine – 0,25, water – 50,0 ml. On inhalation 3-5 ml, before
                    inhalation to add 1,0 ml of  5 % solution of sodium ascorbinati.
4.             Inhalations of mucolytic drugs – 2 % solution of sodium hydrocarbonatis
                     3-5 ml, Acetylcysteini, Bisolvoni, Lasolvani  2-3 ml on inhalation with
                    next aspiration of phlegma.
5.             2,4 % solution of Euphyllin 3-5 mg/kg of mass on 10 % glucose solution
                      10 ml/kg of mass of intravenously slowly.
6.             3 % solution of Prednisoloni 1-2 mg/kg of the masses, one dose
                        intravenously streamly on 10 %  glucose solution 10 ml.
7.             5 % solution of sodium ascorbinati 0,2 ml/kg of the masses
                    of intravenously streamly on 5 ml of  10 % glucose solution .
8.             Cocarboxylazae 5-8 mg/kg of  mass of intravenously streamly
                     on 5 ml of  10 % glucose solution .
9.             Alkaline drink: 1 % solution of sodium hydrocarbonatis  10-15 ml/kg
                     of mass per day.
10.        Vibration massage of thorax in drainage position.
11.        In default of effect and enlargement of respiratory insufficiency – 
                     clearing of bronchial tree by bronchoscope,  artificial ventilation.
                          Sonotherapy at bronchiolitis

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