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Approach to infant wheezing

2 min read

Approach to Infant Wheezing

Dr. Faten Zaidan

CASE 1

  • 2 years old fully immunized boy is brought to ER for sudden onset of barking cough associated with inspiratory stridor.
  • He has moderate suprasternal retractions and stridor.
  • Lungs fields are clear on auscultation.
  • What is your next step in management?
    • Dexamethasone with no response give Epinephrine - trial with humidified oxygen
    • Mild: stridor moderate - severe: destating.

unlikely epiglottis due

  • fully immunized
  • cough

CASE 2

foreign body aspiration deep sulcus - diaphragm depressed

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CASE 3

  • Mother brings her 6 week old girl who has high pitched inspiratory voice that worsens with excitement or crying.
  • There is no respiratory distress or hoarseness in her voice.
  • What is your diagnosis?
    • laryngomalacia
  • What is your management?
    • reassurance

CASE 4

  • An infant has biphasic stridor, poor feeding and respiratory distress.
  • You suspected vascular compression of the trachea.
  • Which test is the most sensitive and specific which you would do?
    • MRI angiogram

CASE 5

  • 2 years old child acutely developed severe respiratory distress and stridor.

  • He is unable to swallow secretions.

  • Body temperature is 40 C.

  • HR 190/min, RR 50/min, BP 80/40 mmHg.

  • He looks toxic, drooling and in distress.

  • What is your diagnosis? -epiglottis (drooling, cant swallow, toxic looking, tripod position)

  • What would you do? -Dont touch, Call ENT, OR

CASE 6

  • A teenager is eating peanuts.
  • He laughed so he choked and started coughing.
  • He appears anxious and cannot produce sound.
  • He is no longer coughing.
  • What would you do?
    • CPR

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