168. Peds lower airway obstruction

Question 1

3 physio causes of obstruction

Answer 1

1. bronchoconstriction
2. mucosal edema
3. pulmonary secretion

Question 2

8 Sx to assess

Answer 2

Mental status
HR
RR
O2 sat
wheeze
insp:exp ratio
accessory muscle use
PEFR

Question 3

MGMT of mild asthma

Answer 3

• MDI is at least as effective as nebs
  o Shorter LOS
• Q20min for first hour
• 2-8 puffs depending on weight
• sustained improvement after 60 minutes can be DCed
• if no steroids in ED, then none at home
• can think about starting an inhaled steroid

Question 4

MGMT of moderate asthma

Answer 4

• main med is SABA
• adjunct ipratropium and steroid
• benefit of IB may be 60 minutes later
• PO steroid just as effective
• Dex has better half life
  o 0.6mg/kg
• continuous nebs may be preferable to intermittent

Question 5

MGMT of severe asthma

Answer 5

• restlessness or lethargy
• extreme tachypnea or tachycardia
• may need non-rebreather
• may need IV if cannot tolerate PO meds
• can give IM epi
• MgSO4 has good evidence
  o hypoT can be minimized by giving over 20 minutes
• possible use of heliox

Question 6

define bronchiolitis

Answer 6

• acute infection that results in inflammation of small airways in < 2yo
• wheeze and WOB
• more common in < 12mos

Question 7

7 factors to assess degree of bronchilotis

Answer 7

Feeding
SaO2 on RA
RR
retractions
Accessory muscle use
Wheeze
Air exchange

Question 8

CXR finding of bronchiolitis

Answer 8

o Hyperinflation, atelectasis, parabronchial cuffing

o Not recommended

Question 9

MGMT of mild bronciolitis

Answer 9

nasal suction

trial of SABA

Question 10

MGMT of mod/severe bronchiolitis

Answer 10

O2
SABA
possible hydration PRN
consider neb epi
consider nebulized hypertonic