BY

: FAUZIAH RUSLI

DEFINITION

•Inflammation of the bronchioles
•Viral infection (RSV) >>

ETIOLOGY

• 95% patients are < 2 years old • 75 % patients are < 1 years old
EPIDEMIOLOGY

• Viral infection  inflammation  obstruction bronchiolus (oedem, mucus secretion ext)  lymfosit peribronchial  disturb gas exchange in lung imbalance perfution ventilation  hypoxemia  tissue PATOFISIOLOGY hypoxia


       

Upper respiratory tract infection (runny nose, cough) Fever Increased work of breathing Wheezing Cyanosis Grunting Vomiting Irritability poor feeding or anorexia

       

Tachypnea, >50-60 breaths/m, nostril breathing Tachycardia, Fever, usually in the range of 38.5-39°C Diffuse expiratory wheezing Ronkhi Intercostal retractions Cyanosis Apnea, especially in infants younger than 6 weeks Palpable liver and spleen from hyperinflation of the lungs and consequent depression of the diaphragm

flat diafragm. infiltrate Laboratorium • Leukositosis • Blood gas analysis .extrusion cavity of intercostal.Radiology • Normal • Hyperinflation pulmo.

1-0.Suportive • Supplemental Oxigen • Restoration and/or maintenance of fluid balance • Apnea monitoring if indicated by age or history • Monitoring body temperature Medical therapy • Bronchodilator .2 mg/kgBB/dose  IV • Ribavirin (viral infection) • Antibiotic (bacterial infection). severe condition . for repair gas circulation • Dexamethasone 0.

      RSV IG baby age <24 month. or premature baby (age < 35 weeks) Giving Palivizumab Minimal brings baby to public place Cleans hand if you contact baby Avoids smokes of cigaratte and air poluttion Avoids baby contact with person have upper respiratory infection .

Mycoplasma Pneumonia. Bacterial Pneumonia. Apnea Pediatrics.          Asthma Bronchitis Congestive Heart Failure and Pulmonary Edema Pediatrics. Viral . Foreign Body Ingestion Pediatrics. Pneumonia Pneumonia. Aspiration Pneumonia.

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Kulim • Come in to hospital: Mei 24th 2011 .N • Address :Jl. SS • Age : 1 years 9 month • Father/ Mother : Mr.JT/Mrs.Patient identity : • Name : by.

ANAMNESE Given by : alloanamnese : patient’s mother and father Chief complain : breathless since 2 days before came to the hospital .

nosebleeding (-). treambles (+). pale(-). delirium (-) . irritable(+). ronkhi (+). didn’t depending activity. difficult to breastfeeding. 2 days before came to the hospital. high. increased when didn’t used pillow. vomiting (-). continously. sianosis (-). breathless(+). seizure (-). it’s first time. sweating (-). fever (+).

mucus (+) . but expectorates dificult to released. coughs (+). vomiting (-) 7 days before came to the hospital he got flu. loss weight (-). he can breastfeeding. expectorates (+). sweating at the night (-).  4 days before came to the hospital. Patient always coughs and became fever. it’s first time coughs.

  He had came to the hospital (RSUD Rokan Hulu. 2 days before came the hospital) and had given antipiretik for fever Because breathless didn’t decrease he reffered to RSUD AA .

   Asthma (-) Alergy (-) Congenital heart failure (-) .

    Asthma (-) Alergy (-) Coughs (+) she’s sister TB(-) .

elementary school graduate education impression : low economy . elementary school graduate education. had habit for smoking Patient's mother: housewives.000/month.1.000.   Patient's father: Farmer. earning Rp.

The patient was born by spontaneous. enough month .  During pregnancy. drink herbal (-). not smoking and not drinking alcohol. didn’t regularly examined by the midwife.

 Breastfeeding  until now  porridge tim  starts 4 month old  Family food  starts 1 years old .

      Hepatitis B  2x BCG  1x DPT  3x Polio  2x Measles  1x Immunizations not complete .

     Sit  6 month Stands up  12 month Walking  1 years 3 month Speaking  1 years 9 month Impression  physical and mental development little late .

one house containing 5 people. good ventilation. Patients living in permanent homes. home environment dusty Impression: not good .

enough filling. reguler Breath : 50x/minute Temperature : 37.General status : severe illness Conciousness : lethargy Vital sign : Pulse : 146x/minute.8 0C .

H= 146 cm  BB/U = 6. Nutrition : W= 6.5 Kg.5/6.9x 100%= 690 ccal .2% (Good)  Calory = 6.9x 100% = 94.

mongoloid facies. tenderness aurikuler (-). symetry . Head  circumference: 45 cm (normosefaly. not easily removed  Eyes: sclera icteric (-/-) konjungtiva anemis (-/-). . serumen (-). light reflex + / +  Ears: normal form. discharge (-). fontanel  close  Hair: black color. isokor pupil.

neck stiffness (-) . wide tongue not hiperemis . tonsils T1-T1  Neck: enlargement of the KGB (-). Nose: norstil breathing (+) no deviation of the septum. pharyngeal mucosa not hyperemis . concha oedem (-)  Mouth: lips moist. mucous (-). cyanosis (-). mucous membranes moist.

Pal  fremitus right= left . rhonky (+/+). strydor (+) .Aus  vesicular right = left. wheezing (+/+). thorax wall movement rigth=left.Per sonor right= left .Ins  symetry form right=left.Lungs: . long expiration . intercostal retraction (+). tacycardi (50x/minute).

 Heart:  Ins : ictus kordis (-)  Palp : ictus kordis palpable at RIC V LMCS  Per : left heart border RIC V LMCS. right heart border liniaright parasternalis  Aus : heart rhythm regular. BJ additional (-) .

 Per : tympani  Aus : bowel sound (+) normal  GENITALIA: no deformity . lien not palpable. flat. venektasi (- ).  Palp : supel. ABDOMEN  Ins : : symmetry form. hepar not palpable.

Brudzinki II (-). refilling capiler 3”. syanosis (-). Extremity  Edema (-/-). Kernig (-) . clubbing finger (-)  Excitatory Meningeal :  Stiff neck(-). Brudzinki I (-). warm acral.

0 Leukosit : 15.3 vol% N=28-42 GDS: 114 mg/dl  Urine :     Color : yellow Clarity: clear Proteinuri : (-) Glukosa = (-) Micros : erytrocyt (+) 0/LP. Epitel : (-) . leucocsyt : 2.0-14.000-17.500 Trombosit : 549.1gr% N=9.000-400. Blood :      Hb : 11.000/mm3 N=150.000/mm3 N=6.000 Ht : 32.

amoeba (-). Feses :  Makroskopik : yellow.erytrosyt (-) . worm egg (-)  leucocyt (-). blood(-). mucus (-).

  Heart lungs  normal  infiltrate at right and left pulmo .

it’s first time coughs. continous Coughs (+). but expectorates dificult to released. 7 days before came to the hospital he got flue. high. difficult to breastfeeding Fever (+). 4 days before came to the hospital expectorates (+).    breathless (+) 2 days before came to the hospital increased when didn’t used pillow. mucus (+) .

Alergy (-).     Irritable Asthma (-).Congenital heart failure (-) history Sister had got coughs Father had smoking habit Home environment dusty .

strydor (+) . wheezing (+/+). Breath: 50x/mnt  Thorax  rhonky (+/+). General status : severe illness  conciousness : lethargy  Noistril breathing  HR : 146x/mnt.

000/mm3 increase Na+  130 mmol/l  decrease Radiology  lungs   infiltrate at right and left lung .   Trombosite  549.

 BRONCHIOLITIS .

 BRONCHOPNEUMONIA .

 BLOOD GAS ANALYSIS .

       Bedrest Oxygen 1-2l/mnt with nasal prongs IVFD with KA EN 1B 24 drip/mnt Parasetamol syrup 3x0.4cc Inj.dexamethasone 3x0. Ceftriaxone 2x250 mg IV Inj.6 mg IV Nebulizer with ventholin ½ ampoule / 6 hours .

 PROGNOSIS  Quo ad vitam : Dubia ad bonam  Quo ad fungsionam: Dubia ad bonam .

.

RR: EN 1B 24 (+) 44X/mnt. wheezing (+/+). RCT 2 -Ceftriaxone decrease second 2x250 mg -Eyes  pupil 2/2. /6 hours Parasetamo l syrup Date Subjective Objective . (I) light reflex +/+ dexamethas -Torgor  good one 3x0. . w: 6.6 -Thorax  ronkhy mg (+/+).Assesme Therapy nt 25/5/ Fever (+). -Nebulizer intercostal retraction ventolin ½ (+). -IVFD KA eathless P:130x/mnt.br .9kg drip/min appetite -Worm acral.Conciousness : bronchioliti -Bedrest 2011 coughs (+).VS :T : 37.6oC. severe illness -O2  1-2l/m s irretable.

Conciousness : bronchioliti -Bedrest 2011 coughs (+).9kg drip/min appetite -Worm acral. -IVFD KA breathless P:130x/mnt.6 -Thorax  ronkhy mg (+/+). RCT 2 -Ceftriaxone decrease second 2x250 mg -Eyes  pupil 2/2. severe illness -O2  1-2l/m s irretable. /6 hours Parasetamo l syrup Date Subjective Objective . 44X/mnt.VS :T : 37. . -Nebulizer intercostal retraction ventolin ½ (+). wheezing (+/+). w: 6. (II) light reflex +/+ dexamethas -Torgor  good one 3x0. .Assesme Therapy nt 26/5/ Fever (+).6oC. RR: EN 1B 24 (+).

breathl ess . BAB (+) Objective . wheezing (+/+). P:133x/mnt. long expiration. ronkhy (+/+).Date Subjective 27/5/ Fever (+).Conciousness : moderate illness -VS :T : 38. RR: 49X/mnt. irretable. appetite decrease. 2011 coughs (+). epigastrium retraction. Assesme Therapy nt bronchioliti -Bedrest -O2  1-2l/m s -IVFD KA EN 1B 24 drip/min -Ceftriaxone 2x250 mg (III) dexamethas one 3x0.6 mg -Nebulizer ventolin ½ /6 hours Parasetamo l syrup .3oC. -Thorax  suprasternal retraction. vesiculer.

RR: 56X/mnt. BAB (+) . vesiculer. ronkhy (+/+).6 mg -Nebulizer ventolin ½ /6 hours Parasetamo l syrup .Date Subjective 27/5/ Fever (+). Assesme Therapy nt bronchioliti -Bedrest -O2  1-2l/m s -IVFD KA EN 1B 24 drip/min -Ceftriaxone 2x250 mg (IV) dexamethas one 3x0. long expiration. wheezing (+/+).Conciousness : moderate illness -VS :T : 38.breathl ess (+). appetite decrease. epigastrium retraction. 2011 coughs (+). BAK (+) Objective .9oC. P:130x/mnt. -Thorax  suprasternal retraction.

wheezing (+/+).6 mg -Nebulizer ventolin ½ /6 hours -Parasetamol syrup 3x0. epigastrium retraction. .3oC. -Thorax  suprasternal retraction. 011 coughs (+). irretable.Date Subjective Objective Assesment Therapy -Bedrest -O2  1-2l/m -IVFD KA EN 1B 24 drip/min -Ceftriaxone 2x250 mg (IV) dexamethason e 3x0.breathles s (+) . P:133x/mnt.4 cc -Aminofusin 50cc/day 28/5/2 Fever (+). RR: 49X/mnt. BAB (+) . appetite decrease. vesiculer. ronkhy (+/+).Conciousness : bronchiolitis moderate illness -VS :T : 38. long expiration.

6 mg -Nebulizer ventolin ½ /6 hours -Parasetamol syrup 3x0. 011 coughs (+). BAB (+) .4 cc 29/5/2 Fever (+).Conciousness : bronchiolitis moderate illness -VS :T : 38.3oC. RR: 46X/mnt.breathles s (+) . . wheezing (+/+). epigastrium retraction. vesiculer. long expiration. appetite decrease.Date Subjective Objective Assesment Therapy -Bedrest -O2  1-2l/m -IVFD KA EN 1B 24 drip/min -Ceftriaxone 2x250 mg (V) dexamethason e 3x0. ronkhy (+/+). P:129x/mnt. -Thorax  suprasternal retraction.

appetite good. RR: 40X/mnt. BAB (+) .breathles s(+) . epigastrium retraction(-). wheezing (-/). vesiculer.Conciousness : bronchiolitis moderate illness -VS :T : 36. P:100x/mnt. 011 coughs (+). -Thorax  suprasternal retraction (-).6 mg -Nebulizer ventolin ½ /6 hours -Parasetamol syrup 3x0.8oC. ronkhy (-/-). long expiration.Date Subjective Objective Assesment Therapy -Bedrest -O2  1-2l/m -IVFD KA EN 1B 24 drip/min -Ceftriaxone 2x250 mg (VI) dexamethason e 3x0.4 cc 30/5/2 Fever (+). .

Conciousness : moderate illness -VS :T : 36. Assesment bronchiolitis Therapy -Bedrest -O2  1-2l/m -IVFD KA EN 1B 24 drip/min -Ceftriaxone 2x250 mg (VII) dexamethason e 3x0.breathless (+) . BAK (+) . long expiration. -Thorax  suprasternal retraction (-). RR: 40X/mnt. appetite good. epigastrium retraction(-). BAB (+) . vesiculer.7oC. 011 coughs ().4 cc 31/5/2 Fever (-). P:98x/mnt.Date Subjective Objective . ronkhy (-/-).6 mg -Nebulizer ventolin ½ /6 hours -Parasetamol syrup 3x0. wheezing (-/).

BAB (+) .9oC. -Thorax  suprasternal retraction (-). RR: 38X/mnt.Date Subjective Objective Assesment Therapy -Bedrest -IVFD KA EN 1B 24 drip/min -Ceftriaxone 2x250 mg (VII) dexamethason e 3x0. . wheezing (-/). P:100x/mnt.Conciousness : bronchiolitis moderate illness -VS :T : 36.6 mg -Nebulizer ventolin ½ /6 hours Patient home 1/6/20 Fever (-). long expiration. appetite good.breathless (-). BAK (+) . ronkhy (-/-). epigastrium retraction(-). 11 coughs (). vesiculer.

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wheezing (+). and environtment dusty .breathless.coughs (+). laboratory finding and radiology Anamnesa age <2 years old. fever (+). flue (+). pyhsical examination. father had smoking habit.sister had coughs.  Bronchiolitis  anamnesa.

noistril breathing But body temperatur little increase.    Pyhsical examination pulse 146x/mnt. long expiration. wheezing. ronkhy. stridor. flue (-). breath 50x/mnt. sianosis (-) Laboratory finding  leucocyte normal Radiology finding  infiltrate right and left lung .

aminofusin 50cc/day Antibiotic had given  in teory given if had got bacterial infection. dehidration. parasetamol syrup 3x0. nutrition In this case  had given oxygen 1-2l/mnt with nasal prongs.   Therapy  suportive  give oxygen. IVFD KA EN 1B 24 drip/mnt. and severe condition .4cc.

  Corticosteroid had given  kontroversial  but had got good respon Nebulizer (bronchodilator) had given  kontroversial  but had got good respon (3-5 days) .

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