pediatric vaccination

Croup vs. Epiglottitis (Peds.)

Pediatrics (neonates to school age; adolescence is another topic) is probably my least favorite specialty to deal with and they are one of the hardest to help at times with all the elements that go with the patient. Whether it is dealing with the sick child or the distraught parents, we must sift through the physical findings and the information from the parents to understand what is going on. This gets especially sticky when it comes to some upper airway complications in the younger group.

Two very common upper airway problems in the younger populations include Croup and Epiglottitis. Both can be dangerous, but require different management when treatment is concerned. This article will give you a brief overview of the pathophysiology, signs and symptoms, treatments, and key points to remember.

Croup

Pathophysiology: Commonly a viral infection (RSV, adenovirus, influenza A and B, etc.) of the upper respiratory system for ages 6 to 36 months. Major inflammation has occurred in the larynx, trachea, bronchi, bronchioles, and lung parenchyma; causing obstruction of the airway. As the swelling progresses supraglottic the patients with begin show signs of respiratory distress. Further along, the patient’s lower airway may begin to begin having atelectasis, due to the lack of air keeping the alveoli open.

Croup is a slow progression of inflammation. Noticing early that the patient has upper respiratory issue is key in the management. Due to the smaller airway of children, we must not hesitate to seat

Signs and Symptoms: The most common sign of croup will be the seal like bark with inspiratory stridor. With this means that the patient is in respiratory distress and quickly heading to failure. If you hear the seal like bark, check the lower lung fields for crackles, because possible atelectasis may have begun.

Commonly more serious during night, awakening them from sleep. Other signs to know include:

  • Tachypnea
  • Retractions
  • Cyanosis
  • Shallow respirations
  • Fever

Treatment: Emergency treatment for croup is a humidified air and a dose of corticosteroids. If in further destress, racemic epinephrine will assist with edema. ETCO2 and O2 readings will help determine if there is retention of gasses, which may lead to acidosis. ABGs will be needed to confirm this as well.

Usually, patients will be able to return home to be monitored. Family should watch for difficulty breath and be using humified air. Antipyretics will assist in keeping fevers down as well.

Epiglottitis

Pathophysiology: Influenza type B, streptococcus pneumoniae or aureus may cause epiglottitis. The epiglottis is a small flap above the glottic opening, which is used to prevent foreign objects entering the trachea. When the epiglottis is infected, with will swell, narrowing the airway for the patient. Increased work of breathing may occur and soon my might have a patient in respiratory failure.

Epiglottitis is a more acute problem, with sudden onset and quick changes to mentation form the restriction of airflow.

Signs and symptoms: As the epiglottis swells, the child may begin to develop stridor. When stridor occurs, we must ask the question is this an object or is this medical. Other signs that might point you towards epiglottitis will be:

  • Sore throat
  • fever
  • Odynophagia
  • Drooling
  • Irritability
  • Cyanosis
  • Tripoding or nasal flaring

Treatment: The most important thing with these patients is to ensure they have an airway. Do not try and examine the patient, especially if you are a paramedic on scene (Load and go). When gathering a medical history, it is especially important to ask for vaccination in the pediatric population. Today, Influenza vaccinations are given to children, but we do have a set population now that do not vaccinate their children. X-rays of neck will be done and a visual examination may be performed. Keep the patient calm at this time, further agitation may cause the airway to swell more.

Patient will commonly receive an antibiotic, such as ceftriaxone, to help with the bacteria. ET tubes may be places in severe cases and usually remain for 24 to 48 hours. Trachostomes may be required, if a ET tube cannot pass the glottic opening.

Key Points

  • Both Croup and Epiglottitis can be dangerous to pediatric patients. If you have a child that has stridor and any signs of distress, they will need immediate attention.
  • Out of hospital, assume epiglottitis and rule it out when you can. This load and go for you
  • Croup X rays may show steeple sign, but epiglottitis won’t

Written by: MEDDAILY

Join me on Facebook!

youtube

Febrile Seizures/Convulsions are not uncommon - around 3% of children by the age of 6 years have had one.

As a parent they are one of the most terrifying events to witness - a lack of understanding, a lack of control of the situation and fear for the worst assures this.

Cause 

Febrile seizures normally happen when an infant with an minor infection has a temperature spike.

If the child appears severely unwell it is important to rule out more serious conditions such as pnuemonia, septicaemia, meningitis and malaria.

Most seizures (simple seizures) last less than 5 mins and have the following symptoms:

  • Stiffening of body, then twitching, or shaking
  • A dazed appearance
  • Eyes may roll backwards
  • Sleepiness afterwards - drowsiness lasting up to an hour

Seizures more rarely can also be ‘complex’ or occasionally can progress as far status epilepticus (as seen in epilepsy).

Action to take

Immediately

Note start time of seizure

Lie child on side with head on something soft

Try to lowertemperature - remove clothes

Give them a drink and some paracetamol (acetomorphin)

Stay with the child at night

After the seizure

Always try to see a doctor soon, they may need treatment for the infection.

Contact the ambulance/doctor immediately if:

  • The seizure lasts more than 5 mins
  • There is no improvement within an hour of the seizure ending
  • There is another seizure soon after the first
  • The child has difficultybreathing
  • There is suspicion of seriousillness

N.B.:

  • Febrile seizures are not normally dangerous, and usually result in no long term damage, or effects on intelligence etc.
  • There is little evidence to support the prevention of febrile seizures 
  • Febrile seizures are NOT a type of epilepsy
  • Febrile seizures are NOT  a reason to avoid vaccination

Diphtheric Conjunctivitis

While many people who know of the infectious disease diphtheria - which we’re protected against by the TDaP vaccine, and which was the impetus for the “Great Race of Mercy”, which is commemorated by the Iditarod - know that it can cause systemic infections and death by suffocation, one of the most common complications is often confused for other conditions.

Diphtheria can cause an acute conjunctivitis if the bacteria infect the conjunctiva of the eye. If it is not brought under control promptly, the toxins exuded by the bacteria can cause necrosis in both the eyelid and the cornea, which can lead to serious vision problems or blindness in patients.

Historically, blindness was a major problem for survivors of diphtheria, scarlet fever, ocular gonorrhea, and smallpox.

Atlas of the External Diseases of the Eye. Dr. O. Haab, 1899.

luckystarsmd  asked:

Hi Wayfaring! Obviously, you are pro-vaccines, and I am too. It drives me crazy when I hear about parents refusing vaccination on faulty premises. There is a post going around tumblr about a pediatrician refusing to treat unvaccinated patients. I understand the risks these unvaccinated patients pose to other patients, but do you think doctors have an ethical obligation to these kids (who didn't choose to not vaccinate themselves)? Would you ban unvaccinated kids from your future practice?

I have a hard time with this concept, and my opinion goes back and forth. 

My office has taken the stance that we will accept children of anti-vax parents because they do need healthcare (and several other pediatricians in the area won’t take them), but we will discuss vaccination with them at every well child visit and make them sign refusals of vaccinations each time they turn them down. 

I have 2 patients who are unvaccinated or under-vaccinated because their parents don’t want to expose them to “chemicals”. One agreed to take some vaccinations once I showed her the labels on the bottles and proved that they did not contain mercury or thimerosol. There are few things that patients do that make me truly angry, but not vaccinating is one of them. It is very close to child abuse in my book.

Ultimately my goal is to take care of patients. If I refuse to see a patient because their family members are unreasonable, I’m not helping the patient. It think that’s what my office is getting at with their policy. However, I still wonder if there should be a “non-vaccinated” waiting area for those patients who come in for sick visits so that they do not infect other people in the waiting room.  

This is a discussion that I’m going to have to have with my future partners in a few months when I start my new job. 

Photo by Armelle Vanderhaghen/MSF

 In this picture MSF staff are removing medical supplies from a recently arrived cargo plane in Paoua. These supplies and the work performed by Médecins Sans Frontières are essential for a country that has been racked by violence since 2012.

   MSF has been performing medical treatment at a hospital in Paoua, Central African Republic since 2006.  Our activities include emergency care, routine vaccination, surgeries, pediatrics, obstetrics/maternity, and HIV-AIDS tuberculosis treatment.

2

Measles - Subacute Sclerosing Pancencephalitis

  • a rare and fatal late complication of measles infection
  • due to an immune reaction to the virus, causing inflammation, swelling of the brain, it is always fatal
  • it may appear years after apparent recovery 
  • rarely seen now in countries with vaccination programmes 
Dear Jenny
The Really Good Pot Roast & Dr. Cranquis
Dear Jenny

An anti-anti-vaccine song which started off as a joke – but the more we thought about it, the more we felt it needed to be sung.

Dear Jenny

[Chorus]

Dear Jenny,

By now you must already know–

Vaccines are safe to undergo,

And so it’s time for you to go.

Dear Jenny,

The data isn’t on your side –

Time to admit that you have lied.

Bye, Bye, Baby.

[Verse #1]

“Thimerosal,” you’ll say to me

“It’s toxic and unsafe, you see.”

But data says that’s not a fact,

So your position can’t be backed–

Besides, it’s all but gone away.

(Bye, Bye Baby…)

[Chorus]

[Verse #2]

You say they aren’t natural –

But arsenic is, that’s factual (that stuff will kill ya)!

You give diseases one more chance,

And depending on who you ask,

You’ve caused over 6,000 deaths.

(Bye, Bye Baby…)

[Chorus]

[Bridge]

Bur your kid just wants your loving–

Doesn’t care about the crap you’re shoveling.

Your hysterics give autism a bad name–

Acting as if it’s a curse,

Hunting for someone to blame.

[Chorus]

Two strong posts about the science behind vaccines for further reading, brought to you by the Anti-Anti-Vaccine Queen, aspiringdoctors:

One

Two

Cranquis Mail: Why vaccinate, when you can medicate? ;)

@simonbitdiddle submitted:

Has there been any statistical research between anti-vaxxers and parents who insist on antibiotics for their children?

HA! I see what you did there!

I don’t know of any studies in this topic – but I gotta admit, it makes my dark twisted heart quiver with sardonic glee to imagine research demonstrating a high statistical overlap between the groups of “parents who refuse to vaccinate their children against dangerous-but-preventable illnesses” and “parents who demand antibiotics to treat symptoms of a viral illness that will go away on its own”…

PS: Don’t bother sending me hate mail about vaccines – I’ll just refer you to my colleague aspiringdoctors for a second opinion.