Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more ➡
Standard view
Full view
of .
Add note
Save to My Library
Sync to mobile
Look up keyword
Like this
1Activity
×
0 of .
Results for:
No results containing your search query
P. 1
BronsiolitaAcuta

BronsiolitaAcuta

Ratings: (0)|Views: 770|Likes:
Published by Dr Diana Enachescu

More info:

Published by: Dr Diana Enachescu on Jan 17, 2009
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
See More
See less

01/21/2012

 
Pediatrie curs 2 2.10.2001
BRONŞIOLITA ACUTA
Definitie:
E o afectiune respiratorie de etiologie virala a sugarului mai mic de 6 luni, caract.Clinic prin:
expir prelungit
wheezing
stetacustic – raluri sibilante si subcrepitante
rx.: emfizem
Etiologie:
v. sincitial respirator (VSR)
adenovirusuri
v. gripale
rar v. rujeolic
VSR→ cai respiratorii inf. → bronsiole terminale → distrugerea muc. respir., inlocuireacel.ciliate cu cel cuboide fara cili
 bronsiole: ▪ edem al peretelui▪ hipersecretie → obstructie → wheezing
debut necaracteristic: ▪ coriza▪ inapetent / apetit capricios
24-48h: ▪ tuse iritativa▪ wheezing▪ dispnee
Ex. clinic:
▪ agitat▪ ± cianoza perioronazala▪ tahipnee (υ>40/min.)▪ tiraj i.c.▪ expir prelungit▪ wheezing▪stetacustic: raluri sibilante / subcrepitante▪ ficat la 3-4 cm sub rebord:▪ coborarea marg. inf. a ficatului (emfizem) cu marg. sup in sp.VII i.c. stg.▪ IC sec. afectarii pulmonare (marg. sup. in sp.VI i.c. stg.)▪ rx: ▪ orizontalizarea coastelor ▪ hiperinflatia pulm.▪ ocazional – zone de atelectazie segm. / lobara
teste biol. – necaracteristice bolii:▪ hemoleucograma – limite normale pt. varsta (predomina Ly)▪ leucocitoza cu devierea la stg. A formulei leucocitare▪ PCR↑▪ nu face diferentierea infectiei cu adenovirusuri si suprainfectia bacteriana▪ uneori ↑IgG▪ sugarul are antecedente atopice in familie → IgE↑
identificarea ag. etiol.:
1
 
Pediatrie curs 2 2.10.2001
▪ VSR – identificat indirect: in sange Ac (test in dinamica): ziua 1 si 7
dg.retrospectiv
Dg. diferential:
▪ pneumonii virale la pacienti cu handicapuri biol.: rahitism carential (wheezing, rx., biol.la fel)▪ det. Ac anti-VSR in dinamica
dg. retrospectiv▪ IC stg.← malformatie congenitala de cord▪ sdr. de aspiratie de corp strain (sugar >4 luni) → sdr. de penetratie bronsica: cianoza,acces de tuse, dupa ore se amelioreaza starea gen., apoi wheezing▪ rx.: zone de atelectazie decliv fata de corpul strain▪ mucoviscidoza (fibroza chistica de pancreas) – secr. vascoase pulm. → obstructie,infectie → afectiuni pulm. → wheezing▪ ileus meconial la nastere▪ distrofic + infectii respir. repetate + diaree trenanta▪ dg. – proba transpiratiei: Na si Cl >60mEq/l▪ deficit de IgA
s
→ infectii respir repetate▪ anomalii de arc aortic – wheezing▪ RGE - infectii respir repetate▪ astm bronsic(A.B.) – wheezing – prima criza▪ <6 ani → foarte greu de diagnosticat A.B.▪ in familie cu A.B., IgE↑ → poate avea A.B. cu debut la varsta mica
Tratament:
 ▪ internat in spital sugarul <3 luni, prematuri, distrofici▪VSR → bronsiolita acuta → primele ore – crize de apnee▪ regim igieno-dietetic – fara complicatii(IC, I.Resp.Ac.) → alimentatia de dinaintea bolii▪ nevoia de lichide: 150ml/kgC/24h, ≤1000ml▪4 pranzuri pt. a nu da distensie gastrica, impingerea diafragmului▪ IC, I.Resp.Ac.: 100, 80, 50▪ stare gen. grava → perfuzie:cantitatea totala de lichide picaturi/minnr. ore x 3▪ SO
2
↓→ masca / izoleta / cort de oxigen▪ e contraindicata sedarea bolnavului, doar in cazuri extreme cu cloralhidrat, celelalte(diazepam)→ deprimarea centrului respir.▪ fluidifierea secretiilor bronsice:▪ hidratare corecta▪ adm. de mucolitice: Fluimucil fiole▪ bronhodilatator – discutabil: toate subst. Folosite in A.B. act. Pe bronhiile mari, cele micinu au receptori▪Teofilina (Miofilin):tb.100mg / fiole 240mg in 10ml▪doza: 10-15 mg/kgC/24h, adm. la 6/8h, i.v./ per os▪ i.v.- injectat lent pt. ca da agitatie, tahicardie, varsaturi▪ familia: a mai primit la domiciliu? (intoxicatie)▪ da relazarea cardiei → RGE la sugar = de rezerva▪Salbutamol: tb. 2 / 4mg
2
 
Pediatrie curs 2 2.10.2001
▪ doza: 0.1-0.2 mg/kgC/24h,la 8h interval▪ ideal in aerosoli / aparat de nebulizari →efect local▪Glucocorticoizi – efect discutabil▪ justificat doar daca are semne clinice de edem cerebral acut →Metilprednison 10-20 mg/kgC/24h, la 6h intervalHHC (ef. antiinflam.) –folosirea lui favorizeaza evolutia lunga a bolii / suprainfectia bacteriana▪2 fiole(25mg): 5-subst. activa, 20-solvent▪doza 10-15 mg/kgC/24h, la 6h intervalManitol – antiedematos cerebral + diuretic▪20% concentratie▪doza test 0.5g/kgC→ef. diuretic→1-2g/kgC/24h (dozaterapeutica)▪nu are ef. diuretice→FurosemidFurosemid:1-2 mg/kgC/24▪IC → digitalizarea pacientului: Digoxin tb. 0.25mg / fiole de 2ml cu 0.5mg SA▪doza: 0.01-0.04mg/kgC/24h▪1/2 initial i.v., apoi cate ¼ la 3 / 4 / 8h interval▪toata lent i.v.▪apoi doza de intretinere: ¼ din doza de atac(tb.)▪ tratam. Etiol.: Ribavirin – prematuri, distrofici, pacienti cu deficite imune (costa mult) →spitalizare, perfuzie i.v. 12-18h / 24h, cel putin 7 zile▪ antibiotice→ deficite imunologice, copii polispitalizati, copii tratati cu imunosupresive(boala Steel)▪Ampicilina:flacoane de pulberi albe→solvite→incolore▪250-500mg▪doza 150mg/kgC/24h, la 6h interval▪ Gentamicina – fiole▪ ef. adverse: afectare renala si auditiva▪ uree normala▪ 4mg/kgC/24h, la 6h interval▪ Penicilina: flacoane 400.000 / 1.000.000 UI▪ potasica / sodica (de preferat)▪ 100.000 UI/kgC/24h, la 6h interval▪ Cefalosporine de gen. I / II▪ sirop (se evita sub 1 an), tablete, injectabil▪ 50 mg/kgC/24h, la 12h interval▪ gen. III – Rocephin – 1 administrare pe ziBronsiolita det. De adenovirusuri:=obliteranta▪ muc. respir.→ distructie extinsa a epit. Respir.▪ per. de stare→ tablou clinic de bronsiolita ac.▪ reepitelizarea→ cicatrici→afectarea bronsiolelor: nu au epit. ciliat
dispnee,wheezing, agravare progresiva a dispneei→HHCin tratam. / cortizon per os(Prednison tb, 5mg, doza 1mg/kgC/24h, la 6h interval)▪ A.B. – adrenalina 1 diviziune→revine din criza (fara wheezing) 
J
3

You're Reading a Free Preview

Download
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->