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Children with respiratory complaints commonly present to the ED and it is imperative that physicians be able to promptly recognize and treat these disease processes.
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Maintain a high level of suspicion for foreign body aspiration in patients with good history even when presenting with normal examination.
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Provide supportive management in epiglottitis without increasing anxiety or agitation and involve consultants early.
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Bronchiolitis treatment recommendations have changed based on current AAP
Pediatric Respiratory Emergencies
Section snippets
Key points
Epidemiology
Although recognition and management has improved, foreign body aspiration (FBA) remains common in children. FBA can occur in children of all ages, although most occurrences are in children younger than 4 years, with a peak incidence between the first and second birthdays.1 White and colleagues2 reviewed FBA cases from 1955 to 1960 and compared these with FBA cases from 1999 to 2003. Comparison revealed similarities in the types of aspirated foreign bodies. Organic foreign bodies were the most
Epidemiology
Epiglottitis is a severe potentially life-threatening condition in which there is acute inflammation of the epiglottis and surrounding tissues. Inflammation and edema lead to progressive airway obstruction and can cause respiratory arrest. It is most often caused by bacterial infection but can also occur as a result of thermal or inhalational injury or local trauma.54 Before the advent of the Haemophilus influenza type B (Hib) vaccine, Haemophilus influenzae caused almost all pediatric cases of
Summary
Pediatric respiratory illnesses are a significant cause of morbidity and mortality. Children with respiratory complaints commonly present to the ED and it is imperative that physicians are able to promptly recognize and treat these disease processes.
References (89)
- et al.
Prevention and management of aerodigestive foreign body injuries in childhood
Pediatr Clin North Am
(1996) - et al.
Airway foreign bodies (FB): a 10-year review
Int J Pediatr Otorhinolaryngol
(2000) - et al.
Clinical experiences of removing foreign bodies in the airway and esophagus with a rigid endoscope: a series of 3217 cases from 1970 to 1996
Otolaryngol Head Neck Surg
(2000) Plastic laryngeal foreign bodies in children: a diagnostic challenge
Int J Pediatr Otorhinolaryngol
(2005)- et al.
The utility of adding expiratory or decubitus chest radiographs to the radiographic evaluation of suspected pediatric airway foreign bodies
Ann Emerg Med
(2013) - et al.
Foreign body aspiration in children: value of radiography and complications of bronchoscopy
J Pediatr Surg
(1998) - et al.
What is the diagnostic value of flexible bronchoscopy in the initial investigation of children with suspected foreign body aspiration?
Int J Pediatr Otorhinolaryngol
(2007) - et al.
Predictors of symptoms are different from predictors of severe exacerbations from asthma in children
Chest
(2011) - et al.
The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity
J Pediatr
(2000) - et al.
Substitution of metered-dose inhalers for hand-held nebulizers. Success and cost savings in a large, acute-care hospital
Chest
(1992)
Corticosteroid therapy for acute asthma
Respir Med
Oral versus intravenous corticosteroids in children hospitalized with asthma
J Allergy Clin Immunol
Two days of dexamethasone versus 5 days of prednisone in the treatment of acute asthma: a randomized controlled trial
Ann Emerg Med
A single dose of intramuscularly administered dexamethasone acetate is as effective as oral prednisone to treat asthma exacerbations in young children
J Pediatr
Albuterol nebulized in heliox in the initial ED treatment of pediatric asthma: a blinded, randomized controlled trial
Am J Emerg Med
Heliox vs air-oxygen mixtures for the treatment of patients with acute asthma: a systematic overview
Chest
Childhood asthma: a guide for pediatric emergency medicine providers
Emerg Med Clin North Am
Asthma requiring mechanical ventilation. A low morbidity approach
Chest
Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children
Lancet
Evaluation of the utility of radiography in acute bronchiolitis
J Pediatr
Acute lower respiratory tract infections in nonhospitalized children
J Pediatr
Pediatric respiratory infections
Emerg Med Clin North Am
Comparison of pediatric airway foreign bodies over fifty years
South Med J
Diagnostic evaluation of foreign body aspiration in children: a prospective study
J Pediatr Surg
Foreign body in the airway: a review of 202 cases
Laryngoscope
Utilization of low-dose multidetector CT and virtual bronchoscopy in children with suspected foreign body aspiration
Pediatr Radiol
Indications for flexible versus rigid bronchoscopy in children with suspected foreign-body aspiration
Am J Respir Crit Care Med
Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma
Acad Emerg Med
The pediatric respiratory assessment measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers
J Pediatr
Prospective evaluation of two clinical scores for acute asthma in children 18 months to 7 years of age
Acad Emerg Med
Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma
Cochrane Database Syst Rev
Efficacy of bronchodilators administered by nebulizers versus spacer devices in infants with acute wheezing
Pediatr Pulmonol
A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children
Crit Care Med
Continuous versus intermittent beta-agonists for acute asthma
Cochrane Database Syst Rev
Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature
Health Technol Assess
Cost-effectiveness of metered-dose inhalers for asthma exacerbations in the pediatric emergency department
Pediatrics
Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis
Thorax
Combined inhaled anticholinergics and beta2-agonists for initial treatment of acute asthma in children
Cochrane Database Syst Rev
Early emergency department treatment of acute asthma with systemic corticosteroids
Cochrane Database Syst Rev
Early administration of systemic corticosteroids reduces hospital admission rates for children with moderate and severe asthma exacerbation
Ann Emerg Med
Systemic corticosteroid therapy for acute asthma exacerbations
J Asthma
Triage nurse initiation of corticosteroids in pediatric asthma is associated with improved emergency department efficiency
Pediatrics
A comparison of oral dexamethasone with oral prednisone in pediatric asthma exacerbations treated in the emergency department
Clin Pediatr
Cited by (11)
Pediatric respiratory tract foreign bodies in children: A systematic review
2023, Auris Nasus LarynxCitation Excerpt :Pediatric respiratory emergencies are an important cause of emergency department (ED) visits and respiratory failure is a major cause of cardiopulmonary arrest [1].
Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting
2023, Journal of Emergency MedicineHigh risk and low prevalence diseases: Adult epiglottitis
2022, American Journal of Emergency MedicineCitation Excerpt :In addition to antibiotics, nebulized epinephrine can be used in adults with epiglottitis to assist with airway bronchodilation and reduce edema; however, data suggesting improved patient-centered outcomes with nebulized epinephrine are lacking [28,37]. Caution is recommended in children regarding nebulized epinephrine as it may cause additional agitation, laryngospasm, and rapid deterioration without proven benefit [42-44]. The use of corticosteroids by any available route (e.g., IV, intramuscular [IM], per os [PO]) in epiglottitis remains controversial, though between 20 and 83% of epiglottitis patients receive corticosteroids [23,29].
Analysis of the Use of Non-Invasive Lung Ventilation Support in Newborns and Young Children after Cardiac Surgery
2023, Ukrainskyi Zhurnal Sertsevo-sudynnoi KhirurhiiNoninvasive ventilation in children
2019, Acta Medica Saliniana
Disclosure: The authors have nothing to disclose.