It’s that time of year! All the children have been coming in with respiratory distress. These days, most often it’s a child with bronchiolitis. But it’s also important not to forget about the kids coming in with croup, anaphylaxis, airway obstruction, and the rare but scary epiglottitis.
Management?
As always…ABC’s.
1. Administer high flow O2 via NC or face mask
2. Consider obstructed airway vs. anaphylaxis as causes of respiratory distress
3. Stridor at rest? Think croup.
a. Epi 3mg nebulized OR racemic epi nebulized
4. Get IV access (in real life, depending on age of the child I feel like this doesn’t always happen, but it’s important for children in respiratory distress who can decompensate quickly)
5. STEROIDS!! (ONLY if 2 years or older)
a. Dex 0.6mg/kg to max of 12mg or methylpred 1mg/kg to max of 60mg
If EMS suspects Epiglottitis, EMS will NOT attempt advanced airway – will only ventilate with bag valve mask and transport ASAP
Last but not least, OLMC (which we are all experts on now after Vic’s great emails the other week)
- EMS must call if kid is <2 y/o in respiratory distress and wants to give steroids
KEY POINTS:
- Croup = stridor + retractions + barking cough
- Epiglottitis = stridor + retractions + muffled voice + high fever (TOXIC APPEARING)
- Unvaccinated = high risk for epiglottitis
- Airway obstruction (foreign body, mass) = biphasic stridor
- Don’t agitate a child already in respiratory distress
- Dex > methylpred in kids
And if you want more... www.nycremsco.org
Jennifer Wolin, MD
Emergency Medicine PGY-2 Resident Physician
Maimonides Medical Center