Acute Bronchiolitis: History-Taking with Full Clinical Examination

Acute Bronchiolitis: History-Taking with Full Clinical Examination


Patient History

1-Year-Old Infant:

GP referral to Paeds ED: Bronchiolitis

Reduced fluid intake/wet nappies

ANP Assessment: POPS=3

PMH: Ex prem 32/40. Ventilated 24 hours, surfactant then extubated to air. Bilateral ear skin tags.

Phototherapy for jaundice

Home @ 2/52 age

Meds: Nil

Imms: UTD

Allergies: Nil known

Only child – mum 13/40 weeks

Parents well – mum has 2 uteruses!



  • Increased work of breathing (with mild recession)

  • Bilateral coarse crackles/wheeze consistent with Bronchiolitis

Systemically: looked well

  • Abdo: soft (left-sided), bloated + wind! Mild tenderness on palpation (right)

  • Bowel sounds heard (left)

  • Large mass (left-sided) – liver at 5cm, hard ++

  • Ears: Skin tags bilateral

  • Nil else found on examination


  • Bronchiolitis Day 4 – reduced intake <50%

  • Space-occupying lesion

  • ? Liver disease

Plan: admit to ward

  • Observe fluid intake ? NGT required

  • Maintain SaO2 above 92%

  • Discussed findings with senior

  • Cannula/Bloods & USS


Blood Results

  • FBC: slightly raised platelet count

  • U&E, Lactate: Coag, CRP, LFT all normal

Blood Results from CAU

  • LDH: Lactate Dehydrogenase 1865 (normally 180-430)

Ultrasound Scan

10.1cm x 9.3cm mass – under liver to umbilical area, right side of abdomen.

No renal tissue identifiable – liver, left kidney, bladder all normal.

  • ? Mesoblastic Nephroma

  • ? Wilms’ tumour



  • Importance of top-to-toe examination

  • ? Focused assessment by GP

  • Reassess

  • Sometimes expect the unexpected


Wilms’ tumour: surgery, chemo completed and now doing well

Emergency Department Prescribing Audit (2017/18)

Emergency Department Prescribing Audit (2017/18)

Lightning Learning: Perimortem C-section

Lightning Learning: Perimortem C-section