epiglotittis treatment for the BLS staff...

[WTEngel]

Also, for whatever reason the last word was cut off in my post above, basically I was saying we were using epi 1:1000 for epiglottitis and racemic for croup, respectively.

Racemic epi will do wonders for your croupers, if you can get past the point where they are coming unglued because you are giving them a neb treatment. That's the catch 22 with these URIs is that most interventions only make the problem worse in the immediate sense, until they have had time to take effect...so these kids almost always get worse before they get better.

 

[TransportJockey]

Do you carry racemic or are you using 1:1000?

1:1000 only... Never seen it used for either yet though. Then again I don't htink I've seen a single pedi since I started working down here

 

[CAOX3]

We carry 1:000 nebs, and had racemic up until about two years ago at the bls level.

Ive used racemic a few times with marked improvement in croupy kids, they replaced it with 1:000 for all upper airway distress wich I haven't used as of yet. I believe the racemic was removed due to the rebound effects and the admission status, I don't know if that's changed but we don't carry it anymore.

I wasn't that keen on using it at first because the education wasn't really there, as I studied it more I got more comfortable with administering it, but I still would usually get a doc on the phone just to run the presentation by him first.

 

[CodyHolt83]

I was interested in the Epiglottitis section of EMT as well. Is sounds like the best treatment is high-flow O2, position of comfort, rapid transport, and try not to make the pt talk at all. I have never even heard about it, but it was an interesting topic to me. I guess I'll go google it now.

 

[CAOX3]

Humidified is going to be your best bet if you have that available

 

[TransportJockey]

Humidified is going to be your best bet if you have that available

humidified is easy. Mask + SVN + Normal saline from an IV bag.

 

[usalsfyre]

The LAST thing I'm going to do is touch this kid's airway, as long as he is doing a somewhat decent job of maintaing it. Absent signs of hypoxia, we're not even going to bother him with O2. Just a nice, quiet, easy ride to an ED that can deal with an airway disaster if it should happen. I am going to have every airway tool available to me out and ready, up to and including a cric.

Luckily for parents and EMS, kids are vaccinated against the most common causative organisims for epiglotitis.

 

[TransportJockey]

The LAST thing I'm going to do is touch this kid's airway, as long as he is doing a somewhat decent job of maintaing it. Absent signs of hypoxia, we're not even going to bother him with O2. Just a nice, quiet, easy ride to an ED that can deal with an airway disaster if it should happen. I am going to have every airway tool available to me out and ready, up to and including a cric.

Luckily for parents and EMS, kids are vaccinated against the most common causative organisims for epiglotitis.

SHould be vaccinated. I know of a couple hippy parents that I've run done emergent IFT for their kids with epiglotitis because they didn't believe in shots.

 

[Veneficus]

SHould be vaccinated. I know of a couple hippy parents that I've run done emergent IFT for their kids with epiglotitis because they didn't believe in shots.

This is actually becomming more common in all places around the globe.

Because of negative publicity and a lot of people who don't know as much as they think they do about medicine, the "no vaccination" campaigns are gaining traction.

I guess you could call it a very cruel for of natural selection.

 

[WTEngel]

You know what I found interesting when I was working in the pediatric world...the kids who werent vaccinated would for the most part end up vaccinated by proxy. Because 95% of the children around them were vaccinated against the common diseases, they would not contract them, therefore the children could not transmit them. With such a small pool of children who could transmit the diseases, there wasn't a very high occurrence of them getting sick.

Now, the real scary part was if these kids did happen to be exposed, they got incredibly sick. There was also a higher incidence of them having issues later into their teens and adulthood.

It always fascinated me how these parents would react to you asking about their child's immunization status during the triage process versus in the social setting. In the social setting around friends and peers, they would act almost smug or high and mighty about their decision. During the triage process or when dealing with medical personnel, they acted almost embarassed.

Just thought this was interesting to point out...

 

[uhbt420]

keep the child calm and call ALS. if no ALS, get to the hospital ASAP. yesterday, if possible.

i had the misfortune of having one of these pts a few months ago. my partner thought it was croup and figured it was a good idea to check the mouth and palpate the trachea. fire department had to cric the kid after that.

 

[WTEngel]

Even if it was croup messing with the trachea and doing anything to the airway that was not absolutely necessary was a bad idea.

Do not mess with these kids. They get angry, and then can not breathe.

 

[Aidey]

You know what I found interesting when I was working in the pediatric world...the kids who werent vaccinated would for the most part end up vaccinated by proxy. Because 95% of the children around them were vaccinated against the common diseases, they would not contract them, therefore the children could not transmit them. With such a small pool of children who could transmit the diseases, there wasn't a very high occurrence of them getting sick.

Herd immunity