EMS World

JAN 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 34 of 51

34 JANUARY 2019 | EMSWORLD.com BONUS CONTENT: THE PEDIATRIC AIRWAY physician may opt to treat with steroids. Pertussis, on the other hand, is bacte- rial and can affect us at any age. Accord- ing to the CDC it is most prevalent in chil- dren under 1 year, followed by children between 7–10. 4 Treatment for pertussis is often time-dependent, as it is a bacte- rial infection and can rapidly get worse. Early identification and treatment with antibiotics are critical. The CDC recom- mends considering treatment before lab results have been completed. In the prehospital environment, we again find that treatment with cool mist or nebulized saline and rapid but calm transp or t to the neare s t appropriate pediatric facilit y will be our treatment of choice. A more frightening prospec t to the prehospital provider is epiglottitis, also know n a s supra glot titis . Hib, or Hae- mophilus influenzae b, is a common bac- terial cause of epiglottitis. According to the Mayo Clinic, "Routine Hib vaccination for infants has made epiglottitis rare, but epiglottitis remains a concern." 5 Epiglottitis can be caused by either a viral or bacterial infection, or in some cases a combination of the two. It can also be caused by trauma to the upper air way. Although rare, epiglottitis is con- sidered a true life -threatening emer- gency and must be treated emergently. Remember that with epiglottitis, aggra- vation or stimulation of that swollen area can cause the airway to close immediately. A s a rule these patients need to be taken to the OR, where personnel will have th e abilit y to p er for m a rapid - sequence or surgical air way if the first attempt fails. As prehospital providers our best inter vention may be no inter ven- tion at all: If the patient is maintaining their air way and adequately per fusing their brain, the less direct inter vention we do, the better. Less-Common Causes Of course there are other, less-common c aus e s of up p er-air way o bs tr u c tio n. Things to keep in mind include upper- air way abscesses, phar yngeal, peritonsil- lar, or retrophar yngeal; congenital mal- formations; tumors; or even just lots of thick secretions. Respirator y syncy tial virus (RSV) sea- son, fall and early winter, will turn that lovable 3-month-old into a never-ending snot factor y. Babies cannot breathe the way they want to because they are pour- ing snot. They cannot eat because they cannot breathe, and they cannot sleep. It is all because of the snot! There isn't a magic bullet to cure RSV; it will persist for a month to six weeks. The younger its victim is, the more likely they will need to be admitted to the hospital because they cannot protect their air way and must receive around-the-clock comfor t care and frequent suctioning. 6 Prehospital pharmacological inter- vention for upper-air way obstructions is relatively limited. Racemic epinephrine is still considered the first-line emergent pharmacologic treatment for inspirator y stridor, steroids second, and pathogen treatment a s the definitive long-term care. Remember the ef fec tiveness of CROUP PERTUSSIS (WHOOPING COUGH) EPIGLOTTITIS RSV CAUSES Virus that infects the upper airway, normally parainflu - enza, can be RSV Bordetella pertussis bacte - ria that infects the respira- tory system, often acquired from family members who have a milder form of illness Most commonly a bacterial infection H. influenza type b (Hib) Virus SIGNS & SYMPTOMS Low, barky cough (seal bark) Rapid, high-pitched cough- ing and a whooping sound while inhaling Violent rapid cough fol - lowed by loud whooping sound on inspiration Wheezing, rapid breathing, and a severe cough; fever may also be present TREATMENTS Cool-mist vaporizer, Tyle- nol, steroids, fluids, racemic epinephrine, hospitalization in severe cases Tylenol, fluids, and antibi - otics; hospitalization and oxygen therapy may be required in serious cases Antibiotics and supportive symptomatic therapies Tylenol, fluids, antiviral medication, a bulb syringe to suction mucus, and a cool-mist vaporizer, though hospitalization may be required if the child has dif - ficulty breathing DURATION Typically 3–5 days but can last up to two weeks Weeks, sometimes up to a few months, potentially over two months if the child is young and has not been immunized Typically 1–6 weeks Around 3–7 days, but some children may develop chronic lung disease

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