Bronchiolitis (세기관지염)

The Root of Ambulatory Care (외래 진료 지침서) 전체 목록 보기
KEYWORDS: ..최근 가족 중에 호흡기 감염을 앓은 적이 있는 주로 2세 이하 소아에서 생긴다. ..Most common organisms - Respiratory syncytial virus (50%) - Adenovirus 1. Dyspnea 2. Fussiness 3. Poor feeding ..초기엔 일반감기처럼 콧물, 코막힘, 기침이 나고 열도 날 수 있어 감기라고 치료하지만 호흡이 빨라지고 쌕쌕 소리가 나는 등의 증세가 나타나면 그제 서야 모세기관지염을 진단하게 된다. 1. Fast breathing 2. Nasal flaring 3. Chest retractions 4. In severe cases, cyanosis 1. Pulse oximetry 2. Chest radiography ▶ Film shows hyperinflation without focal infiltrates. 3. ABGA in severe hypoxia 4. CBC Bronchiolitis Key symptoms Key signs Key signs Chest radiography or Hospitalization for fast breathing (by WHO) Age of Child Respiratory Rate Birth to 1 month > 60 /minute 1 month to 1year > 50/minute 1 year to 5 years > 40/minute ..Prevention in premature infants : premature infants may benefit from using either palivizumab or Respiratory Syncytial Virus(RSV) immune globulin, which should be administered just prior to RSV season. 1. Nebulized bronchodilator ..Ventolin.. Res Soln. 5mg/ml 0.5ml + 0.9% N/S 2ml qid ..Berotec UDV.. ..Bricanyl Respule.. (2ml) 0.08ml/kg q 4hrs 2. Oral β2 agonist agent ..Berotec.. 2.5mg 1T, 0.25mg/kg/d # 3 3. Epinephrine ..0.03 ml/kg + N/S (1: 1000 dilution) ..0.1cc/kg SQ (1: 10000 dilution) 4. Hydration & humidification 5. Sitting position Symptomatic management ..Antitussive ..Mucolytics ..Ventolin.. - Salbutamol ..Berotec UDV.. - Fenoterol ..Bricanyl Respule.. - Terbutaline ..Usually the course of the disease is short, and after 2 or 3days the child is able 331 The Root of ambulatory care Key treatment Bronchiolitis to return home, with gradual resumption of normal diet and activity. ..증상 악화로 인한 입원가능성을 고려해서 호흡수와 외향적으로 완전히 회복 될 때까지 환아를 매일 관찰하는게 좋다. ..Antiboitics는 controversial 하지만, 2차적 세균성 기관지 페렴발생 시 고려해야 하며, theophylline은 수면무호흡이나 호흡억제가 있는 경우에는 효과적이다. 참고 문헌 J. Dennis Mull : Bronhiolitis, in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed). Philadelphia, Saunders, 2000, P 167-168 Judith Anne Kerber, M.D. : Wheezing, in A Lange clinical manual Family Medicine Ambulatory Care & Prevention, 4th ed, Mark B. Mengel, M.D., L. Peter Schwiebert M.D. (ed). United States of America, The McGrwa-Hill Companies, Inc., 2005, P 396-400 오창석(ed) : 세기관지염, in Complete Guide To Practical Based Prescription Medicine. 서울, 한우리, 2005, P 127-129