Exploring the diagnosis and management of Bronchiolitis in children, with a focus on predicting severity and proper treatment practices. Highlighting challenges in treatment modalities, the use of medications like beta agonists and epinephrine, and the benefits of high-flow oxygen therapy. Discussing the importance of clinical judgment over oxygen saturation levels in discharging children, and evaluating admission criteria for severe cases.
01:03:47
forum Ask episode
web_stories AI Snips
view_agenda Chapters
auto_awesome Transcript
info_circle Episode notes
volunteer_activism ADVICE
Role of Nasal Suctioning
Use nasal suctioning to clear nasal secretions and improve breathing comfort.
Deep suctioning might be linked to longer stays but is often necessary for severe congestion.
volunteer_activism ADVICE
Trial Beta-2 Agonists Carefully
Beta-2 agonists are not generally helpful in bronchiolitis but may be trialed if diagnosis uncertain.
Allow 15-20 minutes post-administration before reassessment for true effect.
volunteer_activism ADVICE
Use Nebulized Epinephrine Sparingly
Nebulized epinephrine may be tried once or twice in patients likely to be admitted.
Do not continue unless there is clear clinical improvement; benefits are short-term.
Get the Snipd Podcast app to discover more snips from this episode
This EM Cases episode is on the diagnosis and management of Bronchiolitis. Bronchiolitis is one of the most common diagnoses we make in both general and pediatric EDs, and like many pediatric illnesses, there’s a wide spectrum of severity of illness as well as a huge variation in practice in treating these children. Bronchiolitis rarely requires any work up yet a lot of resources are used unnecessarily. We need to know when to worry about these kids, as most of them will improve with simple interventions and can be discharged home, while a few will require complex care. Sometimes it’s difficult to predict which kids will do well and which kids won’t. Not only is it difficult to predict the course of illness in some of these children but the evidence for different treatment modalities for Bronchiolitis is all over the place, and I for one, find it very confusing. Then there’s the sphincter tightening really sick kid in severe respiratory distress who’s tiring with altered LOC. We need to be confident in managing these kids with severe disease.
So, with the help of Dr. Dennis Scolnik, the clinical fellowship program director at Toronto’s only pediatric emergency department and Dr. Sanjay Mehta, an amazing educator who you might remember from his fantastic work on our Pediatric Ortho episode, we’ll sort through how to assess the child with respiratory illness, how to predict which kids might run into trouble, and what the best evidence-based management of these kids is.
