Acute Respiratory Emergencies in Children

Question 1

What is CROUP

Answer 1

A syndrome of laryngeal obstruction most commonly caused by a VIRAL infection in the subglottic region of the larynx

Question 2

What is the peak for croup, when is a child least likely to get croup

Answer 2

2 years old, beyond 6

Question 3

T/F: Croup and RDS are more common in boys than girls

Answer 3

True

Question 4

What is Croup season

Answer 4

November to March

Question 5

What is the most common virus to cause croup, other

Answer 5

Parainfluenza 1, Parainfluenza 2 and 3

Question 6

What are the bacterial pathogens that cause croup, what do these also cause

Answer 6

Staph aureus, H. influenza, S. pneumoniae, M. cattarhalis/ Pneumoniae

Question 7

How is croup virus transmitted, incubation period, period of virus shedding

Answer 7

Occurs by direct contact or droplets, 2-6 days, up to two weeks

Question 8

What is the most common symptom of croup

Answer 8

Barking cough with sore throat

Question 9

T/F: Humidifying a cool mist at HOME can aid in dealing with croup

Answer 9

True

Question 10

What are the three possible drug treatments for severe croup

Answer 10

Systemic corticosteriods, nebulized racemic epinephrine, Antibiotics

Question 11

What is the mainstay of treating croup

Answer 11

Corticosteriods: decreases capillary endothealeal permeability, airway inflammation, and laryngeal edema

Question 12

T/F: Croup can only treat severe cases

Answer 12

False: Corticosteriods is indicated for mild, moderate, and severe croup

Question 13

What is the preferred corticosteroid and dosing for croup, alternative

Answer 13

Dexamethasone: 0.15-.6 mg/kg as a SINGLE DOSE IM or PO (max of 10mg), Prednisone: 1 mg/kg as a SINGLE DOSE PO (max of 60 mg)

Question 14

T/F: There is no difference in giving dexamethasone oral or IM

Answer 14

True

Question 15

How does oral dexemethasone compare to oral prednisone in treating cases of croup

Answer 15

No difference in mild/moderate cases, less ED visits with Dexamethasone

Question 16

What is the dose that should be used in moderate to severe cases

Answer 16

.6 mg/kg as single dose IM or PO (max of 10mg)

Question 17

When should inhaled corticosteriods be given for croup

Answer 17

Reserved for moderate to severe cases in children who cannot take by mouth or cannot tolearate dexamethasone

Question 18

What is the approved inhaled cortiosteroid for croup at what dose

Answer 18

Budesonide: 2mg in 4 ml NS nebulization as a single dose

Question 19

What is nebulized racemic epinephrine used in croup

Answer 19

Morderate to severe cases, requiring mechanical intubation

Question 20

T/F: Nebulized racemic epinehrine can be an alternative solo therapy to treat croup

Answer 20

False: Nebulized racemic epinephrine should be used as ADJUNCTIVE therapy for short-term treatment

Question 21

What patients are contraindicated in using nebulized racemic epinephrine

Answer 21

Contraindicated in those with ventricular outlfow tract obstruction

Question 22

What is the nebulized racemic epinephrine solution used and at what dose

Answer 22

2.25% solution: 0.25ml (less than 6 months) or 0.5ml (greater than 6 months) (Dilute in 2 to 3 ml of NS administered via nebulizer over 15 min)

Question 23

If antibiotics are used what are used

Answer 23

Cefuroxime OR combination with nafcillin and ceftriaxone

Question 24

When is broncholitis is most often seen in children, peak

Answer 24

Less than two years old, infants less than 6 months old

Question 25

What is the most common cause of broncholitis

Answer 25

Respiratory syntical Virus, influenza

Question 26

What are the risk factors for severe bronchiolitis

Answer 26

Age less than 3 months, history of prematurity (less than 37 weeks gestation), hemodynamically significant cardiac disease, chronic lung disease of prematurity

Question 27

What are the severe symptoms of bronchiolitis

Answer 27

Apnea, hypoxemia, severe respiratory distress

Question 28

What respiratory rate for bronchiolitis should be in the hospital

Answer 28

Greater than 60/min

Question 29

What is the supportive therapy

Answer 29

Hydration

Question 30

What drugs are no longer approved for broncholitis

Answer 30

Bronchodilators (albuterol)- increased heartrate/no change in hospitalization or oxygen therapy, nebulaized racemic epinephrine- treats symptoms but can be used as rescue for SEVERE only, cortiocsteroids- prolong shedding making it worse, antibiotics- reserved for concomitant bacterial infection, nebulized hypertonic solution- may be considered for infants with mild to moderate to hospital

Question 31

How can broncholitis be prevented

Answer 31

hand decontamination, away from tobacco smoke, exclusively breastfeed for six months, limit exposure to childcare centers

Question 32

What can be given for passive immunity

Answer 32

Palivizumab: binds F protein of RSV (per month)

Question 33

What is the dosing for palivizumab how many doses can be given

Answer 33

15 mg/kg IM monthly during RSV season (Up to 5 doses November to March)