Airway suction, oxygen devices and nebuliser technique: Case

This bronchiolitic infant is hypoxaemic and tiring on low-flow oxygen, and the immediate priorities are to clear the secretions, state an oxygen target and escalate the device, and decide on inhaled therapy. Each step depends on understanding the device and the physics, not on repeating a routine. [3]

Clinical findings

The key findings are the copious secretions, the high respiratory rate, the marked recession and nasal flaring that show the infant is working hard and beginning to tire, and the SpO2 of 88 percent on low-flow oxygen that confirms he is failing the current device. The diffuse crackles and wheeze fit bronchiolitis. The reduced air entry reflects both the secretions and the small-airway obstruction. [1]

The candidate should recognise why nasal cannula is failing: it is a variable-performance device whose estimated FiO2 of 24 to 40 percent is diluted further by the infant's rapid recessive breathing, and the nasal secretions block the obligate nose-breather's airway. They should note that the infant is alert but tiring, which is the inflection point at which escalation is needed before exhaustion. [1]