5 year old difficulty breathing

alcoholwipe

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You are dispatched at 2am to a gated community residence. For a 5 year old difficulty breathing.

Fire is dispatched and gets there 15 minutes before you.
When you arrive on scene fire states the patient "looks crappy" and is "unhappy"

As you enter scene mother says child felt unwell today and "was hot" was sleeping in bed with her but did not have difficulty breathing until now. Patient is drooling and has some accessory muscle usage, clothes have been removed by mother prior to fire arrival. Pulse ox is 100% as fire have them on 15ltr, BP 92/60, HR 130, temp 102.6 Lungs clear and equal rate of 34 slightly shallow. Patient gaze tracks normally, responding appropriately. Good color albeit a bit red/flushed.

No past medical history, mother gave Tylenol on instruction from nurseline 4 hours ago. No issues.
Visualization of the mouth looks normal apart from some excessive drooling.


Children's specialty hospital 40 minutes west. Normal ER with OR in hospital 10 minutes east.
 

GMCmedic

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Upper airway sounds? Stridor? Is child talking.
 

DesertMedic66

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Epiglottitis.
5ml nebulaized epi 1:1 and an easy transport to the ED 10 minutes away.
This.

Fits the clinical criteria for it. Keep little dude calm and do a gentle transport to your closest.
 

DesertMedic66

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Geeze guys. I was trying to drag it out a little bit...lol
Kinda hard to drag it out when it seems to be a very classic presentation of a topic that is covered in all levels of prehospital care.
 

DesertMedic66

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If the cric needs to be done and it is in your protocols to do so, then yes it should be done in the field.
 

DesertMedic66

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I personally feel that is a bit fast on this patient. What is your concerns for immediate cric.
I only said if it does need to be done then it should absolutely be done.

Based on the statement “difficulty breathing increases and strider is now heard” doesn’t mean it needs to be done right this second but it is certainly heading that way. So it might be a good idea to get out your supplies.

One may also be able to make an argument for a very mild dose of Versed IN which may allow the patient to tolerate the nebulized epi/racemic epi.

Trying to start a line on this patient is likely to only increase the rate at which the airway is closed.
 
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alcoholwipe

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I only said if it does need to be done then it should absolutely be done.

Based on the statement “difficulty breathing increases and strider is now heard” doesn’t mean it needs to be done right this second but it is certainly heading that way. So it might be a good idea to get out your supplies.

One may also be able to make an argument for a very mild dose of Versed IN which may allow the patient to tolerate the nebulized epi/racemic epi.

Trying to start a line on this patient is likely to only increase the rate at which the airway is closed.
Is racemic epi still in your protocols for epiglottis? The research shows neutral benefit and even negative due to disturbing the airway.
 

DesertMedic66

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Is racemic epi still in your protocols for epiglottis? The research shows neutral benefit and even negative due to disturbing the airway.
Our pediatric ED doc, pediatric intensivist, and medical directors left it in our guidelines for our newest revisions.
 

DesertMedic66

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Ah it was removed from our guidelines for Epiglottis prehospotal due to neutral and negative research
Ours isn’t “if epiglottis then give”. It’s if you have stridor then it’s something you can consider.
 
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