Pediatrics
Pediatric Respiratory Distress
Pediatrics

Pediatric Respiratory Distress

Croup, epiglottitis, bronchiolitis, FB aspiration, neonatal lung disease.

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◆Croup (laryngotracheobronchitis)

  • •Toddler + barking cough + inspiratory stridor at rest + viral URI prodrome
  • •Parainfluenza most common
  • •Mild: dexamethasone single dose
  • •Moderate/severe (stridor at rest): nebulized epinephrine + dexamethasone
  • •Steeple sign on neck X-ray (not always needed)

◆Epiglottitis

  • •Unvaccinated child + fever + drooling + tripod + muffled voice
  • •Hib historically (declining); now GAS, Staph aureus, S. pneumoniae
  • •Thumb sign on lateral neck X-ray
  • •Secure airway in OR with anesthesia + ENT — DO NOT examine in ED
  • •Then ceftriaxone + vancomycin

◆Bronchiolitis

  • •Infant <2 years + viral URI + wheezing + crackles
  • •RSV most common
  • •Supportive care (hydration, suctioning, O₂)
  • •Hospitalize if hypoxia, dehydration, respiratory failure
  • •Palivizumab prophylaxis for high-risk (preterm, CHD, BPD)

◆Foreign body aspiration

  • •Toddler + sudden unilateral wheezing + hyperinflation + unresponsive to albuterol
  • •Right main bronchus most common
  • •Inspiratory + expiratory CXR shows air trapping
  • •Rigid bronchoscopy is definitive

◆Neonatal respiratory distress differential

  • •NRDS (surfactant deficiency): premature + ground-glass + air bronchograms + low volumes
  • •TTN: term C-section + mild + fluid in fissures + improves in 24–48 hr
  • •MAS: term/post-term + meconium fluid + coarse infiltrates + hyperinflation
  • •Pneumothorax: sudden crash + asymmetric breath sounds + hyperlucent side + mediastinal shift
  • •Neonatal sepsis: temperature instability + lethargy + diffuse illness
  • •TEF: choking with feeds + cannot pass NG tube
  • •CDH: scaphoid abdomen + bowel sounds in chest + severe distress at birth
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