432 Emergency Medicine
bronchiolitis.Diagnosis is made clinically on the basis of the constellation
of symptoms, as this patient demonstrates. Patients who are at risk of
increased disease severity are those with chronic lung disease, especially
ex-preemies, those with an immunocompromised condition, and those with
complex congenital heart disease. These patients are eligible for receiving
palivizumab, an injectable antibody that confers passive immunity and can
reduce the likelihood of severe lower respiratory tract disease caused by RSV
in susceptible individuals. The condition associated with RSV infections
overlap with those of other respiratory tract pathogens including rhinovirus,
parainfluenzavirus, coronavirus, echovirus, and coxsackievirus. The clinical
condition of bronchiolitis is caused by RSV in approximately 70% of cases,
especially during the peak months of November to April. The diagnosis is con-
firmed by a rapid antigen test of a nasal aspirate, but this is typically only use-
ful in patients whose diagnosis is unclear or in whom management may be
different based on concomitant conditions. Management is largely supportive.
A variety of medications including albuterol, aerosolized epinephrine, and
corticosteroids are often administered. However, none have been shown to be
consistently beneficial in treating the symptoms or reducing the duration of ill-
ness. Respiratory precautions are necessary to limit transmission.
Foreign body aspiration (a)can happen in children this age and, if
undetected initially, can cause similar symptoms. Often a radiograph will
show an ingested object or stridor may be present. It is believed that bron-
chiolitis is a precursor to asthma (b)and that infants who develop bronchi-
olitis are more likely to develop asthma as they get older, though the
diagnosis of asthma does not apply to someone with their first wheezing
episode at this age. Pneumococcal pneumonia (c)is the predominant cause
of bacterial pneumonia in this age group although the incidence has declined
with the consistent administration of Prevnar, a conjugated vaccine against
this pathogen that significantly reduces the incidence of serious (invasive)
disease by this pathogen. This patient would have received two doses of the
vaccine by this age if he is current on his shots. Pneumococcus can super
infect patients as well, but this clinical scenario is classic for bronchiolitis.
Parvovirus B19 (e)is the etiologic agent of Fifth disease. Fifth disease is a
mild illness that occurs most commonly in children. The child typically has
a fever associated with a “slapped-cheek” appearance to the face and a lacy
red rash on the trunk and limbs.
391.The answer is b.(Pediatric Advanced Life Support Provider Manual,
2006.)There were recent changes in the Pediatric Advanced Life Support