Pediatrics
A 4-year-old child presents with shortness of breath and cough following flu-like illness for 2 days.
Examination reveals child in severe distress with increased effort of respiration with bilateral wheeze and prolonged expiatory phase. He had slimier attacks before that required hospitalization. Blood pressure 100/65 mmHg, Heart rate 124 /min, Respiratory rate 33 /min, Temperature 36.6 °C, Oxygen saturation 82 %. Which of the following is the most appropriate management?
الشرح
Core Concept: Acute severe asthma exacerbation in a pediatric patient, characterized by severe bronchospasm, airway inflammation, and hypoxemia.
Clinical Presentation:
- Dyspnea, tachypnea, accessory muscle use, bilateral wheezing, prolonged expiratory phase, and hypoxia.
Diagnosis:
- First-line: Clinical assessment of respiratory distress and pulse oximetry.
- Gold Standard: Clinical diagnosis; peak expiratory flow or spirometry in older, cooperative children.
Management:
- Acute: First-line therapy includes supplemental oxygen, inhaled short-acting beta-agonists (Ventolin/albuterol nebulization or MDI with spacer), and early administration of systemic corticosteroids (oral dexamethasone or IV methylprednisolone) to reduce airway inflammation. Ipratropium bromide may be added for severe attacks.
- Long-term: Initiate or step-up daily controller therapy (inhaled corticosteroids) and provide an asthma action plan.