Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States.

OBJECTIVE: This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress. METHODS: We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation. RESULTS: Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications. CONCLUSIONS: All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.

Epiglotitis por Haemophilus influenzae tipo b en la era de la vacunación: caso clínico pediátrico / Epiglottitis due to Haemophilus influenzae type b in the vaccination era: pediatric clinical case

La epiglotitis aguda infecciosa es infrecuente en la actualidad, debido a la vacunación contra su principal agente etiológico, el Haemophilus influenzae b. Se requiere alto índice de sospecha ante el cuadro clínico de dificultad respiratoria, estridor, disfonía y fiebre. Se presenta a un niño de 2 años, previamente sano, con esquema de vacunas completas, con dificultad respiratoria aguda y estridor laríngeo, en el que, al momento de realizar la intubación, se realizó el diagnóstico de epiglotitis aguda. Con hemocultivos positivos para Haemophilus influenzae b, cumplió 13 días de tratamiento con ceftriaxona, con hemocultivos de control y cultivo de líquido cefalorraquídeo negativo.

Acute infectious epiglottitis is infrequent at present due to vaccination for its main etiologic agent, Haemophilus influenzae b (Hib). It must be taken into account when we make a differential diagnosis in a child whose clinical symptoms are respiratory distress, stridor, dysphonia and fever. We report a 2-year-old child, previously healthy, whose vaccination calendar was complete, and whose clinical presentation included respiratory distress and stridor; at the moment of the intubation the laryngoscopy showed an acute epiglottitis. Blood cultures were taken, which were positive for Hib. He was treated with ceftriaxone during 13 days, and the control blood cultures and cerebrospinal fluid were negative.

A Rare Case of Candida Epiglottitis in an Immunocompetent Child.

We present a case of acute Candida epiglottitis in an otherwise healthy and Haemophilus influenzae type B-immunized 4-year-old child. A query of the literature reveals this disease to be commonly found in patients who are immunocompromised by problems including human immunodeficiency virus disease and lymphoma and leukemia. However, there are no published reports of acute Candida epiglottitis in immunocompetent and vaccinated patients. Our case should emphasize to the emergency physician the need to remain vigilant for subtle and atypical presentations of airway-destabilizing diseases.

Epiglotite aguda em adulto / Acute epiglottitis in adult

A epiglotite é uma afecção comumente reconhecida por acometer crianças na faixa pré-escolar e por sua gravidade nestes pacientes. Apesar de não ser frequentemente relatada como uma doença que acomete adultos, nos últimos anos houve uma aumento de sua incidência nesta faixa etária.Apresentamos o caso de uma paciente do sexo feminino de 43 anos, em que foi diagnosticado epiglotite através de videolaringoscopia indireta após 5 dias de evolução sem tratamento apropriado. A paciente foi tratada com claritromicina 1g/dia por 14 dias, com remissão completa do quadro.A epiglotite aguda em adultos pode evoluir de forma insidiosa, regredindo com tratamento ambulatorial e raramente levando a complicações obstrutivas. A claritromicina pode ser usada durante 14 dias no tratamento da epiglotite com uma resposta satisfatória.

Epiglotitis: reporte de un caso / Epiglotitis : report of one case

Este es el caso de muerte de un paciente varón de cinco años, quien estuvo en la sala pediátrica del hospital Pedro E. Marchena, Bonao, República Dominicana, en marzo del 1991. A este paciente se le hizo un diagnostico de epiglotitis; buscando en los archivos del hospital no pudimos encontrar otro caso de esta enfermedad en 10 años a lo largo de ese tiempo (últimos diez años); basados en esto queremos presentarle este caso como el primer caso de epiglotitis ocurrido en el Hospital Pedro E. Marchena

Role of sulbactam/ampicillin and sultamicillin in the treatment of bacterial infections of the upper respiratory tract of children.

The combination of sulbactam and ampicillin is a safe and effective therapy for acute otitis media and acute epiglottitis in infants and children. Despite the lack of similar studies proving efficacy for other infections of the upper airway and certain adjacent structures, such as sinusitis, tonsillitis and cellulitis/abscess of the head and neck, this drug combination should also have a therapeutic role in the future for these conditions.

Group A streptococcal supraglottitis.

We describe four children with severe supraglottic infections caused by group A beta-hemolytic streptococci. In each case the clinical presentation suggested Hemophilus influenzae epiglottitis. In only one patient was there significant involvement of the epiglottis, whereas all had striking inflammation of the aryepiglottic folds. Group A beta-hemolytic streptococcus was isolated in blood cultures in two patients and from the supraglottic area and trachea in two others. Fever persisted for 6 to 22 days, and tracheal intubation was necessary for 2 to 16 days, despite appropriate antibiotic therapy. The evolution of streptococcal supraglottitis may be protracted, and it must be managed accordingly.