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Emergency Medical Minute


 

Jan 15, 2024

Contributor: Ricky Dhaliwal, MD

Educational Pearls:

Croup

  • Caused by:

    • Parainfluenza, Adenovirus, RSV, Enterovirus (big right now)

  • Age range:

    • 6 months to 3 years

  • Symptoms:

    • Barky cough

    • Inspiratory stridor (Severe = stidor at rest)

    • Use the Westley Croup Score to gauge the severity

  • Treatment:

    • High flow, humidified, cool oxygen

    • Dexamethasone 0.6 mg/kg oral, max 16mg

    • Severe: Racemic Epinephrine 0.5 mL/kg

    • Consider heliox, a mixture of helium and oxygen

    • Very severe: be ready to intubate

Bronchiolitis

  • Caused by:

  • RSV, Rhinovirus

  • Symptoms are driven by secretions

  • Symptoms:

    • Cough

    • Wheezing

    • Dehydration (often the symptom that makes them look the worst)

  • Age range:

    • 2 to 6 months

  • Treatment:

    • Suctioning

    • Oxygen

    • IV fluids

    • Nebulized hypertonic saline

    • DuoNebs? No.

Asthma

  • Caused by:

    • Environmental factors

    • Viral illness with a predisposition

  • Treatment:

    • Beta agonists

    • Steroids

    • Ipratropium

    • Magnesium (relaxes smooth muscle)

References

  • Dalziel SR, Haskell L, O'Brien S, Borland ML, Plint AC, Babl FE, Oakley E. Bronchiolitis. Lancet. 2022 Jul 30;400(10349):392-406. doi: 10.1016/S0140-6736(22)01016-9. Epub 2022 Jul 1. PMID: 35785792.

  • Hoch HE, Houin PR, Stillwell PC. Asthma in Children: A Brief Review for Primary Care Providers. Pediatr Ann. 2019 Mar 1;48(3):e103-e109. doi: 10.3928/19382359-20190219-01. PMID: 30874817.

  • Midulla F, Petrarca L, Frassanito A, Di Mattia G, Zicari AM, Nenna R. Bronchiolitis clinics and medical treatment. Minerva Pediatr. 2018 Dec;70(6):600-611. doi: 10.23736/S0026-4946.18.05334-3. Epub 2018 Oct 18. PMID: 30334624.

  • Smith DK, McDermott AJ, Sullivan JF. Croup: Diagnosis and Management. Am Fam Physician. 2018 May 1;97(9):575-580. PMID: 29763253.

  • Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child. 1978 May;132(5):484-7. doi: 10.1001/archpedi.1978.02120300044008. PMID: 347921.

  • https://www.mdcalc.com/calc/677/westley-croup-score

Summarized by Jeffrey Olson | Edited by Meg Joyce & Jorge Chalit, OMSII