Pediatric emergency medicine trisk 1664 1664
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (130.22 KB, 1 trang )
absence of any of the clinical clues listed, the first episode of wheezing in an
otherwise healthy child, especially when it occurs during the winter months, is
most likely to represent bronchiolitis.
CHILD 1 YEAR OR OLDER
After 1 year of age, congenital diagnoses in children become less prominent, and
the diagnoses may be organized as described in Table 84.2 . As with those under
1 year old, it is important to note that overlap occurs between age groups. After
age 2 years, symptoms are most likely attributable to asthma, but rare conditions
can occur at any age. Figure 84.2 outlines an algorithmic approach to the more
common causes of wheezing in the child who is older than 1 year. The sudden
onset of respiratory distress and wheezing associated with an episode of choking
and coughing is likely to indicate foreign-body aspiration, particularly in a toddler
who has been eating or playing with a small object. An abrupt onset of wheezing
may also accompany stridor, urticaria, and hypotension in the child with an
anaphylactic reaction. When symptoms present subacutely, associated cough and
rhinorrhea suggest the diagnosis of bronchiolitis in the toddler 1 to 2 years of age.
Most recurrent episodes of wheezing represent asthma, and 80% of children with
asthma will develop symptoms before the age of 5 years. Typically, asthma
exacerbations are precipitated by a concurrent respiratory infection, weather
change, exercise, or allergic trigger, and the patient should clinically improve
with bronchodilator administration. Less commonly, recurrent episodes may
represent an exacerbation of CLD, whereas nonrecurrent episodes may be caused
by pneumonia or bronchitis.
Wheezing and recurrent pneumonia in multiple pulmonary segments are
characteristic of patients with defects in host defense mechanisms, such as CF, an
immunodeficiency, or primary ciliary dyskinesia. When older children are
diagnosed with these disorders, there is usually a history of lower respiratory
illness that began in infancy, as well as other signs and symptoms suggestive of
chronic disease. Repeated pneumonia in the same pulmonary segment in an
otherwise healthy child that begins in late infancy or in early childhood is likely
to represent a previously unrecognized bronchial foreign-body or external
compression of the local airway. In the absence of any of the clinical clues
previously listed, the first episode of wheezing in an otherwise healthy child is
most likely to represent asthma.
It is imperative that all patients with wheezing receive outpatient follow-up
with their primary care provider or, in some instances, with a specialist. With few
