Pediatric emergency medicine trisk 4074 4074
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Management
Patients with right middle lobe syndrome may respond to conventional medical
management along with chest physical therapy and postural drainage. When this
is not the case, bronchoscopy and bronchoalveolar lavage may be helpful to
restore patency of the bronchus, allow better postural drainage, and enhance
antibiotic effectiveness. Although the need for resection is far less common than
in the past, patients with systemic symptoms such as failure to thrive, obstructing
lesions, bronchiectasis, bronchial stenosis, or failure to respond to medical
management should be considered candidates for lobectomy.
ESOPHAGUS-RELATED CAUSES OF AIRWAY DIFFICULTIES
Goal of Treatment
Patients with congenital and acquired esophageal abnormalities may present with
a variety of urgent complaints, the most concerning of which include significant
dysphagia, impacted food or foreign bodies, and in some cases even respiratory
symptoms or distress. In patients with airway concerns, prompt evaluation and
treatment are critical. Familiarity with the common congenital esophageal
anomalies as well as acquired esophageal emergencies and urgencies are critical
to arriving at a prompt diagnosis and delivering the appropriate treatment.
CLINICAL PEARLS AND PITFALLS
Patients with a history of repaired esophageal atresia frequently have
tracheomalacia. If severe, a child may present with episodes of
respiratory distress or “death spells.”
Patients with an H-type esophageal fistula (patent trachea and
esophagus with connection between the two structures) may present
after the neonatal period with symptoms of recurrent choking and
congestion with feeds, or with recurrent pneumonias.
Patients with a history of repaired esophageal atresia may present at
any age with an esophageal stricture. Typical symptoms are
progressive intolerance of solid food followed later by intolerance of
liquids as well. In severe cases, patients may not be able to manage
oral secretions.
Esophageal injuries in older children typically present with significant
symptoms (e.g., retrosternal chest pain, dysphagia, stridor, retching).
Younger children may present with more subtle or vague symptoms.
