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Let me ask what I find to be the much more difficult question.
 
What is bronchiolitis?
wheezing in the winter in kids under 2yo?
under 6mo?
must they be 1st time wheezers?
what about the kid called RAD with hx of wheezing, but presenting during RSV season, or even RSV(+)
do they have to be RSV(+)? if so, by rapid, or only after confirmatory DFA?
anyone who is RSV(+) 
 
I ask this because it is a very difficult question, especially in busy ED's - one that the residents challenge us with every day...any and every variation from 2mo to 2yo, first-time, possible hx of wheezing, recurrent wheezer/RAD, or even the kids with named dx of "asthma", family history, RSV (+/-)...the possibilities are endless.
 
It is a very difficult question - particularly when being evidence-based and tailoring the tx to the individual patient.
 
 
MH
 
Mark A. Hostetler, MD, MPH
Chief, Section of Pediatric Emergency Medicine
Medical Director, Pediatric Emergency Department
Associate Professor, Department of Pediatrics
The University of Chicago
5841 S. Maryland Ave, MC-0810
Office: F1160B (Comer Children's ER)
Chicago, IL  60637
(773) 834-9704
FAX: (773) 702-0414
Pager #3875
Pager direct dial: (773) 845-6770

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________________________________

From: Pediatric Emergency Medicine Discussion List on behalf of Robert Vezzetti, MD, FAAP
Sent: Mon 12/31/2007 3:40 PM
To: [log in to unmask]
Subject: Re: Bronchiolitis



Fred,

I agree with a lot of that.  However, I do try Albuterol at least once in most
kids with bronchiolitis and especially in kids with chronic lung disease
(ex-premies, for example).  I like to use steroids with that same chronic
population or in kids with underlying atopic dispositions (ie eczema) or in kids
where the Albuterol really made a huge difference.  I also rarely get CXR in
bronchiolitics, unless a secondary pneumonia is suspected or if there is
something about their exam or clinical course that is not typical for
bronchiolitis.  A pulse ox of 90 or low-90's in a well-appearing, well-hydrated,
low-risk child (ie, again, kids that don't have underlying lung dz, etc)
generally does not concern me, given the VQ mismatch that goes with
bronchiolitis.  I really push the whole nasal saline with suctioning etc, as I
suspect most people do.  In terms of labwork, in infants less than 2 months old
and above one month of age, or if there is prolonged fever in infants and no
pneumonia, I will often check a urine and urine culture if they are febrile,
especially with fever above 102 or so.  I guess a lot of what we do in
bronchiolitis is part guideline, part training, and part personal preference!

Hope this helps.

Bob

Robert Vezzetti, MD, FAAP
Pediatric Emergency Medicine
Dell Children's Medical Center of Central Texas
4900 Mueller Blvd.
Austin, TX     78723

---- Fred Wu <[log in to unmask]> wrote:
> Dear List,
>
> 
>
> One of our pediatricians recently discussed bronchiolitis management with
> one of my colleagues and I was curious to hear everyone's opinion/practice.
> Her recommendations were:
>
> 
>
> *      No steroids
>
> 
>
> *      No albuterol
>
> 
>
> *      No CXR
>
> 
>
> *      No labs
>
> 
>
> *      Pulse oximetry of 90% is normal in bronchiolitis
>
> 
>
> *      Only criteria for admission is hypoxia, not eating or dehydration.
>
> 
>
> *      Her source is the AAP 2006 Clinical Practice Guideline
>
> 
>
> I agree with some of her recommendations but was curious what everyone else
> thought since many of you are in academic/community pediatric emergency
> medicine practices.
>
> 
>
> Thanks,
>
> 
>
> Fred Wu, MS, PA-C
>
> 
>
> 
>
>
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html




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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html