Pediatric Potpourri: An Overview of Select Pediatric Conditions

Few encounters cause greater anxiety for medical caregivers than a pediatric patient experiencing a life-threatening situation. Although pediatric calls only account for approximately 10% of all EMS calls, they can be among the most stressful.1–5 Caregivers need to be prepared to face these challenges, as prompt recognition and treatment of potentially life-threatening diseases in children in the prehospital setting may have a significant impact on the outcome of the patient’s experience.

Of the 10% of EMS calls that involve pediatric patients, fewer than 5% are for life- or limb-threatening situations.1–3 When EMS does respond to a pediatric call, treatment such as administering oxygen, starting an IV or performing endotracheal intubation can be involved in more than 50% of the cases.

In addition to impacting EMS systems, emergent pediatric situations are also encountered in emergency departments.1–5 Children accounted for nearly 21-million ED visits in 1996.6 In light of these statistics, it is critical for healthcare providers, regardless of their level of training, to be prepared to respond to a call for help that involves a pediatric patient.

This article provides an overview of a potpourri of pediatric topics, including croup, epiglottitis, foreign body obstruction, bronchiolitis, asthma and stridor, all of which may result in a life-threatening situation.

Assessment of the Pediatric Patient With Respiratory

Complaints

Upon initial patient contact, quickly establish the patient’s overall appearance, including vital signs and stability of their ABCs. This can be accomplished by observing the patient, as well as conducting a rapid, yet thorough, physical assessment. Additional tools, such as an EKG, pulse oximeter and capnometer, may also be applied.

If any life-threatening conditions exist, intervention should not be delayed. Providers should attempt to obtain an accurate history. Factors like the presence of fever, time of onset and current medications may influence the care to be provided. Additional historical and physical assessment parameters should include monitoring the patient’s airway, auscultation of breath sounds, noting accessory muscle use, circulation, temperature, neurological status, fluid intake/output and overall appearance/behavior.1,12,13,15

EMS providers should ask the following questions when assessing a child with a complaint: Is this episode chronic or acute? What are the associated symptoms? Is there respiratory distress, fever, toxicity, drooling or cyanosis? Has this condition progressed with age? If so, have the episodes increased in frequency? Have the episodes increased in severity? What causes the patient’s signs and symptoms to worsen (e.g., supine versus sitting, or crying)? Has anything made the child better (e.g., over-the-counter medications)? Has the child experienced any changes in feeding patterns? What are his/her baseline noises? Is the quality of the patient’s cry and voice normal? Table I provides examples of additional factors to consider. By considering the answers to questions like these, in combination with the provider’s clinical judgment and assessment findings, treatment options may become more readily apparent.1,12,13,15

Croup

Croup, or laryngotracheobronchitis, is a contagious viral infection of the subglottic airway region. It is responsible for most cases of stridor after the neonatal period. Children aged six months to three years are most commonly affected, with a peak incidence between 12 and 24 months. As children get older, the incidence of croup declines considerably, especially after age six.

Croup tends not to be as clinically significant in children older than six years because of their mature airway anatomy. Due to the smaller and less-developed airway of the younger patient, airway edema and inflammation have a greater impact in a smaller child than an older, more mature child. While these cases can be successfully managed, there is a 5% recurrence rate. 1,7–13