See this very interesting article: Wheezing in the Pediatric Patient

Some points that I found interesting:

· Regarding RSV: “Increased morbidity and mortality occurs in high-risk patients, including those younger than 6 weeks old, and those with a history of premature birth, hypoxia, congenital heart disease, chronic lung disease or immune deficiency.”

· “While corticosteroids are commonly used in the treatment of moderate to severe asthma, their use in bronchiolitis is limited. They are not considered a standard of care for the management of bronchiolitis (although they are used), and are not recommended for use in previously healthy infants with RSV”

· I found the same information in another Pediatric Emergency textbook; in that book it states that steroids are not indicated at all in the management of bronchiolitis.

· On another note, both the American Academy of Pediatrics and the PALS textbook mention the use of nebulized epinephrine for bronchiolitis. The AAP states that bronchiolitis may be more responsive to nebulized Epi over albuterol (which may be of limited efficacy in bronchiolitis)

· Regarding Asthma: Onset of action for ipratropium can be delayed for up to 60 minutes, however, “despite the delayed onset of action, studies have shown that the use of albuterol with ipratropium is more effective in reversing bronchoconstriction than using albuterol alone.”

Some exam review for Respiratory emergencies:

1. A person who experiences sharp chest pain followed by increasing dyspnea after he or she coughs MOST likely has:

Choose one answer.

A. pleurisy.

B. acute pneumonia.

C. a pleural effusion.

D. a pneumothorax.

2. An otherwise healthy adult whose normal hemoglobin level is 12 to 14 g/dL typically will begin to exhibit cyanosis when:

Choose one answer.

A. hemoglobin levels fall below 12 g/dL.

B. about 5 g/dL of hemoglobin is desaturated.

C. his or her oxygen saturation falls below 50%.

D. 10% of his or her hemoglobin is desaturated.

3. Intrapulmonary shunting occurs when:

Choose one answer.

A. hyperinflated alveoli retain high levels of carbon dioxide.

B. resistance to airflow increases due to bronchoconstriction.

C. nonfunctional alveoli inhibit pulmonary gas exchange.

D. the volume of anatomic dead space suddenly increases.

4. A patient with status asthmaticus commonly presents with:

Choose one answer.

A. compensatory respiratory alkalosis and stridor.

B. physical exhaustion and inaudible breath sounds.

C. audible expiratory wheezing and severe cyanosis.

D. accessory muscle use and inspiratory wheezing.

5.  __________ breath sounds are the MOST commonly heard breath sounds, and have a much more obvious inspiratory component.

Choose one answer.

A. Vesicular

B. Tracheal

C. Bronchovesicular

D. Bronchial

6.

A 29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, tachypneic, and has audible wheezing. You should:

Choose one answer.

A. attempt to slow her breathing with respiratory coaching, administer a nebulized bronchodilator, and transport.

B. start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible.

C. apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.

D. begin assisting her ventilations with a bag-mask device and 100% oxygen and prepare to intubate her trachea.

7. The presence of diffuse rhonchi in the lungs indicates:

Choose one answer.

A. thick secretions in the large airways.

B. isolated consolidation of secretions.

C. right-sided congestive heart failure.

D. air being forced through narrowed airways.

8. Uncontrollable coughing and hemoptysis in a cigarette smoker are clinical findings MOST consistent with:

Choose one answer.

A. acute bronchitis.

B. lung cancer.

C. emphysema.

D. pleural effusion.