Categorias: Todos - steroids - respiratory - improvement

por ayood helo 17 anos atrás

597

respiratory Distress

A patient presented with respiratory distress characterized by stridor and wheezing. Initial treatments included racemic epinephrine, dexamethasone, oxygen, and suctioning. Despite these measures, the patient remained stressed at rest, necessitating the consideration of ICU admission and potential intubation.

respiratory Distress

respiratory Distress

Stridor

atypical
CTA
Bronchoscopy
chest CT
typical
Racemic epi and Dexa one dose; O2; suctioning

stress at rest

ICU

Intubation?

Dexa

Heliax

Improved

Humidified air

wheezing component

Wheezing

Albuterol/Atrovent doubles once or 3
No Improvement, but the child looks comfortabe

Bronchiolitis

supportive tx: O2 ; suctioning

occasinally racemic epi

Improvement

Astham (RAD)

For URI symptoms

Respiratory screen

If +

CXR

Parial Improvement

Steroids

IV Solumedrol

Orapred

inhalers

Albuterol/Atrovent doubles X 3

Albuterol continuous 10, 15 or 20

more than 1 hr

to ICU

Continue Albuterol continues

less than 1 hr

relapse less than one hour off

well for more than 1 hr off

to Floor

Albuterol/Atrovent single or double starting at q2/q1spaced to q4/q2 then q 6/q4

No improvment

Repeat CXR

Atelectasis

Consider Abx for atypical pneumonia

Chest PT, Spirometer

Improvment

Discharge

Consider referring for allergy

Consider Singulair

Consider adding steroids/long acting beta

Advir

Strength 500

Strength 250

strength 100

consider adding inhaer steroids

Pulmicort

Flovent

Consider adjusting the albuterol

Nebulizer

MDI spacer

Orapred 5 d

Complete improvement