Summary of Recommendations for ED Management of the Acute Bronchiolitis in Pediatric Patients November 7, 2019


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Differentiating bronchiolitis from asthma and reactive airway disease in young children can be challenging, and a rapidly changing clinical presentation can confound accurate assessment of the severity of the illness.

Acute bronchiolitis is the most common lower respiratory tract infection in young children that leads to emergency department visits and hospitalizations. Bronchiolitis is a clinical diagnosis, and diagnostic laboratory and radiographic tests play a limited role in most cases. While studies have demonstrated a lack of efficacy for bronchodilators and corticosteroids, more recent studies suggest a potential role for combination therapies and high-flow nasal cannula therapy. Frequent evaluation of patient clinical status including respiratory rate, work of breathing, oxygen saturation, and the ability to take oral fluids are important in determining safe disposition.

This summary of the treatment recommendations for pediatric bronchiolitis, supported by various guidelines provides, a systematic approach to ED assessment of such patients.

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Summary of Recommendations for ED Management of the Acute Bronchiolitis in Pediatric Patients

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What’s Your Diagnosis? a 9-month-old infant gasping for air September 30, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , 1 comment so far

But before we begin, check out if you got last month’s case right, about the 11-year-old boy with acute abdominal pain. Click here to check out the answer!

Case Presentation: an 9-month-old infant gasping for air

As your shift is winding down at 4 AM, a mother brings in her 9-month-old infant, whom she describes as “gasping for air.” The baby has had a runny nose and cough for a few days as well as a low-grade fever, but now he is breathing rapidly and wheezing, with lower intercostal retractions.

The mother states that the infant has had wheezing in the past, and she asks if he might have asthma since “it runs in the family.” She also indicates that in the last 12 hours, he has not taken his usual amount of fluids.

His oxygen saturation level is 87% on room air.

You begin to think… should I treat this as reactive airway disease, asthma, or bronchiolitis? When should I give the patient albuterol, nebulized epinephrine, or oxygen? Does the infant need steroids? You also wonder whether this patient is going to tire and require assisted ventilation or whether there are any other alternatives to intubation.

Case Conclusion

You quickly determined that your patient had severe bronchiolitis, and you knew that aggressive management was required. You placed the patient on pulse oximetry because the infant had wheezed previously, and started a trial of a nebulized bronchodilator with oxygen while closely monitoring his clinical response to treatment. Your patient’s respiratory rate was still in the 70s, with minimal decreases in the work of breathing. His pulse oximetry level was 87% on room air, so you administered supplemental oxygen via HFNC. The patient started to cry without tears, and you noticed his dry mucous membranes, so you administered IV fluids. His respiratory rate was 55 breaths/min with no retractions, and he was able to take his bottle for only a brief period even after the nurse suctioned his nasal secretions. His SpO2 level remained at 90% on room air. You decided to admit the patient because his tachypnea was leading to compromised oral intake and because of his persistent hypoxia, and you kept him on the HFNC in the meantime.

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A 2-year-old girl with upper respiratory infection symptoms — Brain Teaser. Do you know the answer? April 18, 2019


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Test your knowledge and see how much you know about diagnosing and managing pediatric community-acquired pneumonia.


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The correct answer: B.

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Clinical Pathway for Management of Pediatric Patients With Community-Acquired Pneumonia April 15, 2019


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A significant challenge in the management of pediatric community-acquired pneumonia is identifying children who are more likely to have bacterial pneumonia and will benefit from antibiotic therapy while avoiding unnecessary testing and treatment in children who have viral pneumonia.

Worldwide, pneumonia is the most common cause of death in children aged < 5 years. Distinguishing viral from bacterial causes of pneumonia is paramount to providing effective treatment but remains a significant challenge. For patients who can be managed with outpatient treatment, the utility of laboratory tests and radiographic studies, as well as the need for empiric antibiotics, remains questionable.

Clinical Pathway for Management of Pediatric Patients With Community-Acquired Pneumonia

This clinical pathway will help you improve care in the management of pediatric patients with community-acquired pneumonia. Click here to download yours today.