0071643192.pdf

PEDIATRICS

■ Causative organisms include Moraxella catarrhalis, streptococcal

species (especially pyogenes), MRSA as emerging etiology, Klebsiella,

Pseudomonas

SYMPTOMS/EXAM

■ Typically preceded by a viral URI for a few days

■ Fever

■ Rapid and severe inspiratory and expiratory stridor with toxic apperance

Stridor (inspiratory and expiratory)

■ Cough or raspy, hoarse voice

DIFFERENTIAL

■ Epiglottitis

■ Croup

■ Foreign body in airway

■ Viral URI

■ Fever

DIAGNOSIS

■ High index of suspicion based on clinical grounds

■ Soft-tissue neck X-rays demonstrate subglottic narrowing with a rough-

appearing tracheal lining.

■ Bronchoscopy confirms diagnosis.

TREATMENT

■ Antibiotics, eg, penicillinase-resistant penicillin, third-generation cepha-

losporin, clindamycin.

■ Typically requires emergent intubation in the OR.

COMPLICATIONS

Airway compromise and respiratory collapse.

BRONCHIOLITIS

■ Bronchiolitis is a lower respiratory tract viral infection, most commonly

caused by RSV.

■ Other etiologies include adenovirus, parainfluenza, rhinovirus, influenza,

and mycoplasma.

■ Affected children are usually < 1–2 years old, with the most severely

affected infants < 6 months old.

■ The peak incidence is winter to spring.

■ Symptoms may last 3–10 days.

SYMPTOMS/EXAM

■ Wheezing

■ Respiratory distress (retractions, nasal flaring)

■ Tachypnea (often leading to decreased oral intake and dehydration)

■ Hypoxemia

■ Rhinorrhea, fever, and pharyngitis

■ Apnea may occur in infants.

Bronchiolitis: Up to 75% of

cases caused by RSV