Respiratory Distress Emergencies

Questions And Answers

Pneumonia

1 You are called to the house of a 7-year-old male. His mother tells you that he has been coughing for about a week. Yesterday, he developed a fever up to 103°F and today he began coughing more and seemed to be struggling to breathe. What are the first steps in assessing this child?

You should always use the Pediatric Assessment Triangle (PAT), which includes the components of appearance, circulation, and work of breathing. For appearance, you are assessing level of consciousness (awake, responsive, sleepy, lethargic, and so forth). Circulation can be assessed by checking capillary refill and noting the child’s skin tone (i.e., pallor, cyanosis, mottling). Work of breathing can be assessed with respiratory rate, presence of retractions, and any abnormal lung sounds (see Chapter 32 ).

2 You note that the child seems slightly pale and has a respiratory rate of 36 and subcostal retractions. When you listen to his lungs, you note that he has decreased breath sounds and crackles on the right. What do you suspect is causing his symptoms?

The presence of cough, fever, and crackles is suggestive of pneumonia. Community-acquired pneumonia is a common childhood condition.

3 What are the common etiologies and the recommended treatment for community-acquired pneumonia in the pediatric population?

In addition to respiratory support (anything from supplement oxygen to intubation, depending on the level of respiratory distress) and supporting hydration (whether with oral [PO] or intravenous [IV] fluids), antibiotics should be given if you suspect a bacterial etiology ( Table 37.1 ).

Table 37.1

Common Etiologies of Pneumonia in Children and Their Recommended Treatments

AGE GROUP	ETIOLOGIES FOR COMMUNITY-ACQUIRED PNEUMONIA	RECOMMENDED TREATMENTS
Children less than 5 years old	Viral infections including RSV and influenza Most common bacterial cause: Streptococcus pneumoniae Other bacterial causes: Haemophilus influenzae , Moraxella cattharalis , Staphylococcus aureus , and Streptococcus pyogenes	Viral: supportive care Bacterial: amoxicillin (80–90 mg/kg/day PO in two divided doses, adolescent dosing typically maximizes at 875 mg BID, typically for 7–10 days)
Children over 5 years old	Most common bacterial cause: S. pneumoniae Atypical bacterial causes are also common, including Mycoplasma pneumoniae and Chlamydia pneumoniae	For typical bacterial pathogens: amoxicillin (dosing as noted earlier) For atypical bacterial pathogens, use macrolides (for example, azithromycin 10 mg/kg PO on day 1 with maximum of 500 mg/dose, then 5 mg/kg PO on days 2–5 with a maximum of 250 mg/dose)

RSV , Respiratory syncytial virus.

4 What are indications for admission in the pediatric patient with pneumonia?

Hypoxia, dehydration, respiratory distress, comorbidities, complications like empyema or abscess, and failure of outpatient treatment with oral antibiotics.

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