Rsv Bronchiolitis Case Study

What is your differential and presumptive diagnosis at this point? Describe the thought process that selects one of these diagnoses over the other.

Differential Diagnosis: Bronchiolitis, viral Pneumonia, Bacterial Pneumonia, Influenza, Foreign Body

My Presumptive diagnosis given this information is RSV bronchiolitis. The rationale behind this is that it is a common pediatric illness that causes difficulty breathing and a cough. Other clues to this diagnosis include the onset of the disease which was gradually worsening and a low grade fever. Additionally, on physical exam the presence of dull tympanic membranes suggests there is possible otitis media, which is common in children who have bronchiolitis. Due to the nature of the onset and presenting

This virus gets into the epithelium of the bronchioles cells. Once inside of the cell, the virus begins to replicate and spread through the airway. At the same time monocytes and macrophages that are inside of the airways phagocytize the virus and present them on their membrane. This causes an immunologic response that leads to the release of inflammatory mediators. The purpose of these inflammatory mediators is to recruit more cells into the lung tissue to fight off the infection. The more mediators that are drawn into the periphery the greater the pulmonary symptoms will be. The reason for this is because the symptoms are actually a response to the obstruction that the inflammatory mediators and white blood cells cause. This is significant because the bronchioles are very narrow tubes about 2mm in diameter and can be easily obstructed blocking the exchange of oxygen, which produces the high respiratory rate, low oxygen saturation, and wheezes that are heard on physical

Which means instead of opening up the airways it actually causes them to constrict. It is also possible that the introduction of a Beta-2 agonist increased the V/Q mismatch even more because there is an increase blood flow that needs to be perfused. Unfortunately, the obstruction in bronchioles prevents in proper perfusion, because it remains intact and still blocking the airway despite dilation. This results in the body trying to compensate which is why the patients respiratory rate went up and began to show signs of distress.

What are the current practice guidelines for using albuterol for this condition?

Currently there are no recommendations for the use of bronchodilators. There is no evidence to support that the use of this medication actually relieves the symptoms or decreases of the course of the disease. The reason this is so is because bronchiolitis is a disease that is caused by an obstruction in the airway and not a result of the constriction.

Why is the information about the pregnancy important?

The reason the information about the pregnancy is important is because it is helpful and determining how severe the disease could actually. A premature birth increases the severity usually 32 weeks or early is a sign that this infection could require hospitalization. Other birth history that is important is knowing if he has a congenital heart defect or a low birth weight. Which would