Pediatric Diseases (1)

Question 1

Croup (LTB) (Treatment/Management)

Answer 1

MILD CASE

1) Supportive care
- temperature control - cool environment
- adequate hydration & humidification of inspired air
- closely monitor
* vital signs
* degree of retractions
* mental status
* ventilatory & oxygenation status

2) Oxygen therapy 30-40%
3) Cool aerosol mist (face mask, tent)

4) Drug therapy
- racemic epinephrine
- corticosteroids (pt. who does not respond to cool aerosol + racemic epinephrine)

SEVERE CASES

1) Intubation criteria
- lethargic
- severe stridor at rest
- diminished breath sounds
- extreme accessory muscle usage

2) Temperature control - cool environment
3) Adequate hydration & humidification of inspired air
4) Transfer patient to ICU
5) Sedate if necessary
6) Place on T-piece of CPAP

7) Criteria for extubation
- child’s condition is stable
- air leak around the tube (swelling has gone down)

Question 2

Epiglottitis (Treatment/Management)

Answer 2

1) Immediate placement of artificial airway
- endotracheal tube
- tracheostomy if unable to intubate
* transfer pt. to ICU
* sedate if necessary
* place on T-piece or CPAP

2) Oxygen therapy

3) Drug therapy
- antibiotics

4) Criteria for extubation
- child’s condition is stable
- swelling in the airway has diminished

Question 3

Peidatric Poisoning/Toxic Substance Ingestion (Treatment/Management)

Answer 3

1) Supportive care
- stabilization of the cardiovascular & respiratory systems including
* maintenance of an airway, intubate when aspiration is possible
* monitoring
* full resuscitation
* venous access for drug administration
* appropriate weight measurement
* toxicology screening

• once cardiovascular & respiratory systems stabilized then
• prohibit further drug absoprtion
• improve elimination
• manage complications

2) Decontamination
- remove all remaining toxins from child’s skin & mouth
- remove all saturated clothing
- utilize personal protective equipment
- GI decontamination through the removal/dilution of gastric contents & the use of gastric absorptive agents
* syrup of ipecac
* gastric lavage
* activated charcoal
* whole-bowel irrigation

3) Mechanical ventilation for ventilatory failure

4) Antidotes as indicated
- acetylcysteine for acetaminophen
- narcan for narcotics

Question 4

Cystic Fibrosis (Treatment/Management)

Answer 4

1) Airway clearance 4x a day
- chest percussion & postural drainage
- exercise
- PEP therapy
- high frequency chest wall compression
- forced expiration techniques
* active cycle of breathing
* autogenic drainage
* huff coughing

2) Oxygen therapy

3) Drug therapy
- aerosol therapy
* bronchodilator
* mucolytics - pulmozyme
* anti-inflammatory
* advair
* flovent, pulmicort
- hydration - hypertonic saline

4) Inhaled antibiotics
- tobramycin (pseudomonas aeruginosa)
- colistin
- amikacin

Question 5

Bronchilitis (Treatment/Management)

Answer 5

1) Prophylaxis recommedned for infants
- less than 2 years of age who require therapy for chronic lung disease
- born at less than 32 weeks gestation
- with congenital heart disease with cardiovascular compromise

2) Drug therapy
- antibodies against RSV
* intravenous-RespiGam
* intramuscular-Synagis

3) Most cases are treated at home w/ humidification & oral decongestants

4) Severe cases (pt. w/ apnea) are hospitalized & treatment is directed at relieving the airway obstruction & hypoxemia by utilizing
- systemic hydration
- oxygen therapy (hood, mist tent, nasal cannula)
- airway clearance
- Ribavirin aerosol - given via small particle aerosol generator (SPAG) for RSV infection

5) Mechanical ventilation for impending/acute ventilatory failure
- use low RR & long e-time

Question 6

Foreign Body Obstruction

Answer 6

1) Treatment of airway obstruction
2) Bronchoscopy - Rigid
3) Postural drainage & percussion
4) Aerosol therapy w/ bronchodilators