Pediatric Emergencies

Question 1

Croup (laryngotracheobronchitis)

Answer 1

Pathophysiology = an acute viral infection of the upper and lower respiratory tract. Inflammation of subglottic region (level of larynx extending to cricoid cartilage)

Causes - parainfluenza virus*, respiratory syncytial virus, rubeola, adenovirus

Complications - complete obstructions

C/C - SOB, Fever

O - Acute
P - Laying down makes worse
Q - worse on inspiration
R - 
S - 
T - 

H - URI, Low grade Fever
A - Any
M - Any

Pertinent positive/negative
\+ wheezing
\+ inspiratory stridor
\+ nasal flaring
\+ 6 months - 4 years
\+ tachypnea 
\+ cyanosis (late)
\+ autumn through spring (late fall - early winter)

Tx
Semi-fowlers
Humidified O2
Racemic Epinephrine

Question 2

Epiglottitis

Answer 2

Pathophysiology = bacterial infection resulting in inflammation of the epiglottis that causes occlusion of the Epiglottis and supraglottis structures (pharynx, aryepiglottic folds, and arytenoid cartilage)

Causes = Bacterial - Haemophilus influenza type B*, streptococcus, pneumococcus, staphylococcus

Complications = can progress rapidly and become life threatening obstruction (uncommon)

C/C - SOB, Fever, sore throat

O - sudden, goes to bed without symptoms and wakes up with sore throat
P - lying down, swallowing, 
Q - 
R - 
S - 
T - 

H - Any
A - Any
M - Any

Pertinent positive/negative 
\+ Fever (>104)
- barking cough
\+/- inspiratory stridor
\+ drooling (ominous sign of impending airway obstruction
\+ muffled voice
\+ any age( common 3-7)
\+/- s/s respiratory distress 

Tx

• keep calm, avoid crying
• no IV
• cool humidified air
• if arrest, intubate with uncuffed et tube (size 1-2) and IV, maybe needle cricothyrotomy (if unable to get tube and unable to get compliance with BVM)
• rapid transport

Question 3

Bacterial Tracheitis

Answer 3

Pathophysiology = an uncommon infection of upper airway and supraglottic trachea that may occur after viral illness.

Cause = bacterial (staphylococcus)

Complications = airway obstruction, respiratory arrest

C/C

O
P
Q
R
S
T

H - Age 1-5, can be in older children
A - Any
M- Any

Pertinent positive/negative
\+ agitation
\+ cough that produces pus or mucus
\+ high grade Fever
\+ hoarseness
\+ inspiratory and exploratory stridor
\+ throat pain
\+ s/s of respiratory distress

Tx

• airway, ventilatory, circulatory support
• suction
• intubation

Question 4

Asthma

Answer 4

Pathophysiology = chronic inflammatory disease of the lower airway characterized by inflammation, broncho-constriction, and mucus production as a result from autonomic dysfunction or exposure to sensitizing agents

Phase 1

• histamine release and bronchoconstriction
• needs bronchodilators

Phase 2

• bronchiole inflammation
• needs anti-histamatory/steroids (solumedrol)
• give magnesium sulfate when bronchodilators do not work

Triggers = infection, weather, changes, exercise, emotional upset, allergy, virus

C/C - SOB

O
P
Q
R
S
T

H - Asthma
A - Bees, Ants, Spider, peanuts, sea food, some medications
M - Albuterol, Flonase, Atrovent, Bronkodyl,

Pertinent positive/negative
\+ dry cough
\+ expiratory wheezes
\+ s/s of respiratory distress
\+ > 2 years
- Seasonal

Tx

• Ventilatory assistance
• Humidified oxygen
• Rapid transport
• Aerosolized bronchodilators (albuterol, ipratropium, levalbuterol)
• subcutaneous administration (epinephrine, terbutaline with sever respiratory distress or failure
• corticosteroids (methylprednisone) during prolonged transports
• magnesium sulfate and low tidal volumes (5-8 mL/kg) to reduce potential for barotrauma (if patient requires intubation)

Question 5

Pneumonia

Answer 5

Pathophysiology = acute infection of the lower airway and lungs that involves the alveolar walls or the alveoli

Causes = Viral/Bacterial infection, Near drowning, chemical exposure, URI(pertussis or influenza)

C/C

O
P
Q
R
S
T

H - URI (pertussis or influenza)
A - Any
M - Any

Pertinent positive/negative
\+ s/s respiratory distress
\+ grunting*
\+ wheezes
\+ Rhonchi 
\+ crackles* (localized to the effect area)
\+ chest pain*
\+ Fever or hypothermia
\+ decreased lung sounds to affected area

Tx

• O2
• IV for possible dehydration/septic
• transport

Question 6

Bronchiolitis

Answer 6

Pathophysiology = viral infection of the bronchioles of the lower air way with thick mucous production

Causes = viral (respiratory syncytial virus[RSV], parainfluenza virus), spread by respiratory secretions

Complications = generally not serious, respiratory failure

C/C

O
P
Q
R
S
T

H - URI with productive cough
A - Any
M - Any

Pertinent positive/negative
+ winter,spring months*
+