Transport Tips

• It’s especially helpful to keep the patient calm
• Allow parent presence when possible
• Treat fever with Tylenol® or ibuprofen
  
• Cool mist may be used if available*
  
• Cool night air environment is helpful

Racemic epinephrine

• 0.5 cc/kg of 1:1,000 epinephrine (max 5 cc) via nebulizer
• Treatment lasts 2-3 hrs; disease lasts 2-3 days
• Use of epinephrine requires a minimum of 3-hour ER observation so avoid for mild, stable, or improving cases*
• If used, don’t aggravate the patient

*Indications for Epi: Moderate to severe distress not relieved by calming and pain control.

Dexamethasone (In the Emergency Department)

• 0.6–1 mg/kg
• Oral works as well as IM
• Onset < 4 hours
• Useful to give as early as possible

Bronchiolitis is an inflammation of the bronchioles, usually the result of a viral illness. Respiratory Syncytial Virus (RSV) is the most common viral cause but parainfluenza, adenovirus, rhinovirus and now Sars-CoV2 (COVID-19) are other known pathogen causes.

Bronchiolitis

• Most often in children, ages 0 to 24 months
• One of the few viral infections that can cause serious illness in newborns
• Incidence is approximately 2.2 per 100 children annually

Symptoms

• Nasal secretions (lots)
• 1–4 day history of congestion with a low-grade fever
• Parents of infants will often report poor feeding, lethargy, or agitation
• Breathing problems, including wheezing, retractions, and a “noisy” cough

Treatment (supportive care)

• Ensure adequate hydration and oxygenation
  
• Carefully monitor for complications
• The first line treatment in the ED is naso-pharyngeal (nose and throat) suctioning.

1. Thorough suctioning can can greatly improve distress (often no other treatment is needed). Many pre-hospital providers are reluctant to perform naso-pharyngeal suctioning, but it can be your most effective treatment for bronchiolitis.
2. Bulb suctioning is a good tool.
3. To go deeper, 8Fr suction catheter will work well on most pediatric patients. If secretions are thick and the nares are large enough, a 10Fr works better. Measure the distance from the tip of the nose to the ear lobe then insert the catheter into the airway to your measured point. Apply suction as you remove the catheter. Try to keep the treatment under 10-15 seconds and let the child catch his or her breath between attempts. If the child has thick secretions you can use a NS solution to soften things up (0.5mls in neonates to 2mls for older children). Observe the child’s respiratory rate and quality, color, heart rate, and SaO2 throughout the treatment.

• If the child is hypoxic even after suctioning, give oxygen to keep saturations greater than 94%. Hint: infants tolerate a nasal cannula very well and it’s easier than chasing them with blow by.
• Effectiveness of bronchodilators (such as Albuterol) in bronchiolitis is unproven. Our ED’s current practice is to try one nebulized albuterol treatment (2.5mg). If there is no improvement, albuterol is discontinued.
• If the patient continues with severe distress, intermittent apnea, or apparent respiratory failure we implement high-flow, positive pressure ventilation, or endotracheal intubation.

Croup and bronchiolitis are common ailments in the pediatric population. Most patients will recover quickly but as pre-hospital providers you will see the sickest of the sick.

Seizures are a neuromuscular response to an underlying cause such as: epilepsy, hypoxia, hypoglycemia, head injury, recent illness, poisoning, and infection (such as COVID-19). Seizures happen when the electrical system of the brain malfunctions. Brain cells keep firing and the surging energy can cause muscle spasms and unconsciousness.

Clinical Presentation: May include: altered level of consciousness, tonic/clonic muscle movement, eye deviation, tachycardia, tachypnea, bradycardia, bradypnea, twitching, or staring episodes.

Most seizures stop on their own in less than 5 minutes and do not need pharmacological treatment. However, there are medical interventions which should be done during the active phase.

• Apply oxygen: Most patients who have a seizure are hypoxic. Even if they are not hypoxic, oxygen can help slow the progression of a seizure.
• Have suction available.

• Order or prepare medications.
• Check temperature and treat fevers with rectal acetaminophen: fevers can lower the seizure threshold in a patient.
• Gain IV access.

Seizures which last longer than 5 minutes need pharmacological treatment because the longer the seizure, the more difficult it is to stop.

Benzodiazepine treatment is the first-line treatment. Benzodiazepines can be given rapidly through many different routes (IV, IN, PR) and effectively treat seizures. IN Midazolam (Versed) is the first line benzo. A second dose of a benzodiazepine should be given if the seizure does not stop within five minutes after the first dose. If the seizure continues, another class of medication should be used as multiple doses of benzodiazepines have not proven to be effective and are likely to cause respiratory depression.

Key Points

• Medications used to stop seizures often cause temporary respiratory depression so monitor closely for apnea after the seizure is controlled and support breathing as needed.
• Be aware that medication to control seizures may cause hypotension in patients.
• If seizures are due to a traumatic brain injury, actively monitor for hypotension.
• The chance of death or disability increases with duration and frequency of seizures.
• Status epilepticus is defined as seizure lasting longer than 5 minutes or multiple seizures without return to normal consciousness between.
• Often a patient with recurrent seizures may be in non-convulsive status epilepticus in between and may appear post-ictal.
• A seizure burns glucose and hypoglycemia can cause additional seizures. Check and treat for hypoglycemia.

The AAP recommends COVID-19 vaccination for all children and adolescents 5 years of age and older who do not have contraindications with a COVID-19 vaccine authorized for use in their age group.

• Children with previous infection or disease with SARS-CoV-2 should receive COVID-19 vaccination, according to CDC guidelines.
  

• Pediatricians are encouraged to promote vaccination through ongoing, proactive messaging (i.e., reminder recall, vaccine appointment/clinics), and to use existing patient visits as an opportunity to promote and provide COVID-19 vaccines.
  

• Pediatricians’ (and other healthcare providers') role in promoting vaccination among their patient population and in their community is critical, especially among those at highest risk for severe illness, hospitalization, and death from COVID-19, as well as their household contacts.

• For additional guidance on COVID-19 Vaccine for Children (aap.org; https://www.aap.org/en/pages/2019-novel-coronavirus- covid-19-infections/covid-19- vaccine-for-children/).

Children have experienced significant changes in routines and stability related to COVID-19. Medical providers for children are being asked about how to respond to these psychological needs. The National Childhood Traumatic Stress Network (NCTSN) and the Center for the Study of Traumatic Stress (CSTS) provided valuable guidance for medical providers on this issue. See the following links for more information:

• NCTSN- Parent/Caregiver Guide to Helping Families Cope with COVID19
• CSTS- Helping Homebound Children During an Outbreak

The answer is YES!

PECC's are you a Handtevy Instructor? Would you like to be? There is an instructor class happening in March and we have 3 scholarships to cover your cost. Contact Mark Herrera (markherrera@utah.gov) by February 19th if you would like to be considered for the scholarship.

Handtevy Instructor Course

• $299 a person (3 scholarships available for PECCs)
• March 11th, 2022
• 0800-1700
• Mountain View Hospital
• 1000 E 100 N
• Payson, UT 84651

National blood shortage calls for people to donate blood, conserve supplies

The United States faces a severe shortage of blood products and associated supplies. Limited staffing and supply chain issues at the American Red Cross impact both collection and processing, and donations have declined nationally since 2020. The COVID-19 Omicron variant surge compounds blood product needs.

How significant is the shortage? The shortage is so severe that the American Red Cross has declared a national blood crisis. The COVID-19 pandemic has produced a situation in which overall blood donations are down by 10 percent nationally.

Caregivers and their friends and families are invited to donate at the American Red Cross or at ARUP. To find an available appointment may require you to book two or more weeks out, but your donation will still be very appreciated.

Find a drive by clicking the picture above.

Pediatric Education for the Prehospital Provider

Register online at www.peppsite.com. Look up classes in Utah and find the one that works for you. Once you find the class, go to jblearning.com, and look up pepp als in the search tool. Purchase the number ($21.95). Return to peppsite.org to register for the class and follow the prompts.

If you have any questions, please email Erik Andersen at erikandersen@utah.gov or text/call 435-597-7098. Continue to watch the website for additional classes.