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Common Rare
Wheezing in Children
Common Uncommon
Allergies Bronchiolitis obliterans
Asthma Congenital vascular
GERD abnormalities
Infections CHF
Bronchiolitis CF
Bronchitis Immunodeficiency
OSA Tumor
Vocal Cord Dysfunction
Foreign body aspiration
Bronchopulmonary
Dysplasia
History is Key
Appearance is key
Nasal flaring
Grunting
Retractions
Stridor
Lethargy
Cyanosis
Diagnostic Testing
Systemic corticosteroids
If given within 45 minutes of acute exacerbation,
reduce the likelihood of hospital admission
No evidence that IV steroids are more effective
1-2 mg/kg/d for 3-10 days as burst
Methylprednisolone (Medrol)
Prednisolone (Prelone/Pediapred)
Prednisone
Quiz
T/F
Servent and Pulmicort are equally effective for
maintainance therapy in mild persistent asthma.
Long-Term Therapy
Beclomethasone QVAR
Budensonide Pulmicort
Flunisolide Aerobid
Fluticasone Flovent
Triamcinolone acetonide Azmacort
Long-Term Therapy
Increases hyperreactivity
T/F
Theophylline improved lung function in childhood
asthma.
Long-Term Therapy
Theophylline
Increased mean morning peak expiratory flow rate
Immunotherapy
Can be used as an adjunct
Education
Educate to recognize and avoid triggers
T/F
Synagis should be given to all premature infants
during the first year of life.
Synagis
Respiratory/Contact isolation
Vigorous handwashing
Providers must wear masks covering nose and eyes
BronchiolitisDiagnosis
Supportive care
Adequate hydration
Supplemental oxygen if needed
Benefits of hospitalization are for careful monitoring
to maintain patent airway, adequate hydration,
oxygen, and to educate parents
Medications
PRN
Challenges
Ability to make clinical diagnosis
Differentiation of viral vs. bacterial
Inability to determine specific etiology
Selection of appropriate antibiotics
Community acquired pneumonia
Bacterial causes
Viral causes
Age
Season
Immunization status (especially prevnar and
influenza)
Exposure to TB
CAP--PE
Covers S. pneumo
Macrolides are not first line but can be added at 24-48 hours of
M/C. pneumonia suspected
A single dose of ceftriaxone is acceptable, prior to starting
orals, if child is unable to tolerate liquids.
Antibiotics