EMS A to Z: Pediatric Respiratory Illness
Show Notes:
From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn
Introduction
I’ve worked a couple of pediatric ED shifts recently and had a feeling of dejavu with every new patient presentation... 14-month-old with congestion, cough, increased work of breathing, and fever. Fortunately, most of my patients were doing well overall, despite their illness, but that’s not always the case and little kids with difficulty breathing can be scary to care for!
Let’s break down the assessment of these kiddos, review some relevant differential diagnosis considerations, and consider how to treat them in the prehospital setting.
Assessment
Sick vs. not sick
Pediatric Assessment Triangle
Mental status: normal, decreased activity, lethargy
Work of breathing: mild, resp distress, resp failure
Circulation: color, capillary refill
Breath sounds / Chest exam
Upper airway sounds
Lower airway sounds
Retractions
Nasal flaring
Tachypnea / bradypnea
Grunting
Differential Considerations
Bronchiolitis
Occurs typically fall / winter -> spring; October – April
Children < 2 y/o
Symptoms: cough, congestion, fever, increased work of breathing, “wheezing”, tachypnea, poor feeding, dehydration
Treatment: suction, suction, suction, oxygen if hypoxic, occasionally high-flow or CPAP if severe, IV fluids if dehydrated / not tolerating PO
Things like steroids, albuterol, etc. Do not work
Antibiotics are not necessary
Croup
Occurs typically fall / winter
Children 6 mo to 3 years, but can be seen up to age 5
Symptoms: barky cough, fever, congestion, may have stridor
Sore throat, drooling, and difficulty swallowing is not typical of croup
Severity (Westley Croup Score): level of consciousness, cyanosis, air entry, retractions, stridor
Treatment: Nebulized epinephrine, steroids
Cool / cold air may help
Pneumonia
Can occur in healthy children as well as some at increased risk: chronic lung disease, cystic fibrosis, immune compromise
Symptoms: fever, cough, +/- increased work of breathing, retractions, asymmetric coarse breath sounds
Can look very similar to viral illness
Reactive Airway Disease / Asthma
Asthma not typically diagnosed until > 2 years of age, but some children will have evidence of reactive airway disease / wheezing prior to that age
Asthma presents with wheezing, increased work of breathing
If respiratory rate is slowing, mental status is declining, this is indicative of respiratory failure
Treatment: albuterol, ipratropium, steroid, magnesium, IM epi
Other
Foreign body, epiglottitis, etc.
What about the sick kids in respiratory failure?
Support oxygenation and ventilation with BVM and supplemental O2
IV access may be obtained for fluid bolus if evidence of poor circulation (severe tachycardia, poor capillary refill, etc.)
Music: Brit Pop, Scott Holmes Music
