Exploring the diagnosis and management of Bronchiolitis in children, with a focus on predicting severity and proper treatment practices. Highlighting challenges in treatment modalities, the use of medications like beta agonists and epinephrine, and the benefits of high-flow oxygen therapy. Discussing the importance of clinical judgment over oxygen saturation levels in discharging children, and evaluating admission criteria for severe cases.
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Diagnosis After Initial Management
Bronchiolitis diagnosis is less urgent than assessing respiratory and hydration status.
Treatment response helps confirm diagnosis more than early definitive diagnosis.
volunteer_activism ADVICE
Focus on Respiration and Hydration
Assess respiratory and hydration status carefully using age-specific respiratory rates.
Observe work of breathing and feeding to gauge severity and hydration.
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ABCs for Pediatric Assessment
Use the pediatric ABCs: appearance, breathing, and color to guide assessment.
A comprehensive, mostly hands-off approach aids rapid, effective evaluation.
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This EM Cases episode is on the diagnosis and management of Bronchiolitis. Bronchiolitis is one of the most common diagnoses we make in both general and pediatric EDs, and like many pediatric illnesses, there’s a wide spectrum of severity of illness as well as a huge variation in practice in treating these children. Bronchiolitis rarely requires any work up yet a lot of resources are used unnecessarily. We need to know when to worry about these kids, as most of them will improve with simple interventions and can be discharged home, while a few will require complex care. Sometimes it’s difficult to predict which kids will do well and which kids won’t. Not only is it difficult to predict the course of illness in some of these children but the evidence for different treatment modalities for Bronchiolitis is all over the place, and I for one, find it very confusing. Then there’s the sphincter tightening really sick kid in severe respiratory distress who’s tiring with altered LOC. We need to be confident in managing these kids with severe disease.
So, with the help of Dr. Dennis Scolnik, the clinical fellowship program director at Toronto’s only pediatric emergency department and Dr. Sanjay Mehta, an amazing educator who you might remember from his fantastic work on our Pediatric Ortho episode, we’ll sort through how to assess the child with respiratory illness, how to predict which kids might run into trouble, and what the best evidence-based management of these kids is.
Emergency Medicine Cases