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ADVANCED PAEDIATRIC LIFE SUPPORT - part 4

Như là Không có điều trị cụ thể đối với viêm tiểu phế quản, hỗ trợ quản lý IS. Giao oxy ẩm IS vào headbox với tỷ lệ đó sẽ duy trì SaO2 trên 92%, và dịch truyền tĩnh mạch hoặc thông mũi dạ dày đang bắt đầu nếu cần thiết. Xung oxy IS hữu ích trong Đánh giá mức độ nghiêm trọng của thiếu oxy. | THE CHILD WITH BREATHING DIFFICULTIES Bronchiolitis emergency treatment As there is no specific treatment for bronchiolitis management is supportive. Humidified oxygen is delivered into a headbox at a rate that will maintain Sao2 above 92 and intravenous or nasogastric fluids are commenced if required. Pulse oximetry is helpful in assessing the severity of hypoxemia. Because of the risk of apnoea small infants and those with severe disease should be attached to oxygen saturation and respiratory monitors. Antibiotics bronchodilators and steroids are of no value. The precise role of the nebulised antiviral agent ribavirin is unclear and its use should be reserved for children with pre-existing lung disease those with impaired immunity and infants with congenital heart disease. Mechanical ventilation is required in 2 of infants admitted to hospital either because of recurrent apnoea exhaustion or hypercapnia and hypoxaemia secondary to severe small airways obstruction. All intubated infants must have continuous Sao2 and CO2 monitoring. Naso-pharyngeal CPAP may be sufficient ventilatory support for some infants. Most children recover from the acute infection within two weeks. However as many as half will have recurrent episodes of cough and wheeze over the next 3-5 years. Rarely there is severe permanent damage to the airways bronchiolitis obliterans . Background information on asthma and bronchiolitis Acute exacerbation of asthma is the commonest reason for a child to be admitted to hospital in this country. Admissions for acute asthma in children aged 0-4 years increased seven-fold between 1970 and 1986 and admissions for children in the 5-14 age group tripled. In the early 1990s asthma represented 10-20 of all acute medical admissions in children but rates have fallen over the last 3-5 years. There were 24 deaths from asthma in children in England and Wales in 1998 ONS . Consultations with General Practitioners for asthma have doubled in the last 15 years. These .