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