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This issue includes 4 AMA/ACEP category 1, AAP Prescribed CME credits
Authors:
Jennifer Marin, MD, and
Jill Baren, MD
Peer Reviewers:
Ghazala Q. Sharieff, MD, FAAP, FACEP, FAAEM, and
Joseph Toscano, MD
Publication Date:
November 1, 2007, Volume 4, Number 11
Excerpt from the issue…
During mid-winter in the emergency department, a familiar “barking” sound is heard in the distance. As the sound grows closer, you see a 15 month-old boy being carried by his mother, and you note that he is having difficulty breathing as you follow them into the exam room. While you are observing the child, the parents report that he’s had a fever, cough, and a runny nose for two days. Last night, he developed a deep, harsh quality to his cough, and his breathing has become more labored today. The parents report an uneventful birth and neonatal history, there is no history of similar breathing episodes, and his vaccinations are current. You wonder:
What immediate treatment, if any, should be initiated?
What is this child’s most likely diagnosis?
What is the best definitive treatment for this child?
Should you obtain any imaging studies?
Does this child require hospitalization? How will you decide?
Conclusion to the above case study...
The 15-month-old boy who came in with difficulty breathing and a deep, harsh quality to his cough was also found to have inspiratory stridor on examination. He was given a 0.6 mg/kg oral dose of dexamethasone and a 0.5 mL dose of racemic epinephrine. His stridor resolved and, after a three hour period of observation, he was discharged home. His parents were given instructions to follow-up the next day with his pediatrician and to return to the emergency department for stridor at rest or other signs of respiratory distress.
Every emergency physician must be able to recognize, assess, stabilize, and manage a pediatric patient with respiratory distress. The presentation of a child in respiratory distress due to an upper airway infection may consist of fever, difficulty breathing, noisy breathing, irritability, and/or dehydration. This issue of Pediatric Emergency Medicine Practice discusses the epidemiology, diagnosis, and management of upper airway infectious diseases in children. This article will review the emergency physician’s approach to the assessment, stabilization, and definitive treatment of the following common upper airway infections: croup, bacterial tracheitis, retropharyngeal abscess, peritonsillar abscess, and epiglottitis.
