EMS responds to a residence for a seven-year-old male with a cough and trouble breathing. This episode began two hours ago and has been accompanied by a runny nose without any other symptoms. His mother has been treating him with albuterol by a nebulizer, but he has progressively become more short of breath. Past medical history is notable for asthma since infancy, with multiple prior hospitalizations. Learn how to assess, monitor and manage pediatric asthma emergencies, as well as underlying pathophysiologic changes Joey Wahler (Host): Absolutely. Great to hear. Thanks again for the story. And of course, for all the other information. Folks, we trust your now more familiar with asthma in children. Dr. Michael Marcus, thanks so much again.

Dylla L, Acquisto NM, Manzo F, Cushman JT. Dexamethasone-Related Perineal Burning in the Prehospital Setting: A Case Series. Prehosp Emerg Care. 2018 Sep-Oct;22(5):655-658. Dr Michael Marcus: Only that children are a bit less cooperative sometimes. They’re not always able to take the inhaled medications with the right technique and they need that supervision and guidance. The flip side though is that since parents really do control children’s lives and we tend to care for our children better than we care for ourselves, children are more likely to use their medication properly once the parent understands the need for the medication. Shah MN, Cushman JT, Davis CO, Bazarian JJ, Auinger P, Friedman B. The epidemiology of emergency medical services use by children: an analysis of the National Hospital Ambulatory Medical Care Survey. Prehosp Emerg Care. 2008 Jul-Sep;12(3):269-76. Joey Wahler (Host): Wow, what a great story and makes me wonder in closing here, when you’re able to impact lives like that, and I’m sure you’ve done so many times over since, how rewarding is that for you? With inhaled medications, we have different types of devices that can assist the child to use the medication in the best fashion, which will allow the medicine to reach the lungs to the best effect. And so using these assistant devices is an important piece that we add to a child’s therapy where it’s not always necessary in an adult’s therapy.

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Stead L, Whiteside T. Evaluation of a new EMS asthma protocol in New York City: a preliminary report. Prehosp Emerg Care. 1999 Oct-Dec;3(4):338-42.

Finally, fluid shifts into the walls of the lower airway, resulting in inflammation and a decrease in airway diameter. The net result is a narrowing of the small airways with increased resistance to airflow. Dr Michael Marcus: It’s what it’s all about. It’s why I became a physician. It’s what makes the work, the tediousness of writing notes, the headaches of management, it makes it all go away because ultimately that’s what we’re in this for, to help save lives.

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These pathophysiologic changes cause distal alveoli to trap air and become hyperinflated. As the amount of hyperinflated lung tissue expands, the child’s diaphragm is progressively flattened, causing a mechanical disruption of ventilation. Increased workload for ventilation is transferred onto smaller and weaker intercostal and suprasternal muscles, leading to rapid fatigue and onset of respiratory failure. Physically, the patient appears to be in moderate respiratory distress, with suprasternal and intercostal retractions. His vital signs include a respiratory rate of 40/minute, heart rate of 120/minute, and pulse oximetry of 93% on room air. Lung exam is notable for diffuse inspiratory and expiratory bilateral wheezing, poor air movement and a prolonged expiratory phase. The remainder of the examination is unremarkable. Case discussion – Asthma pathophysiology Joey Wahler (Host): Asthma is a condition that adversely affects breathing, so we’re discussing pediatric asthma and how it’s treated. This is Maimo Med Talk. Thanks for listening. I’m Joey Wahler. Our guest from Maimonides is Dr. Michael Marcus, Director of Pediatric Pulmonary Medicine and Allergy Immunology and Vice Chair of the Pediatric Ambulatory Network. Dr. Marcus, thanks for joining us. The EMS1 Academy features “Capnography for BLS: Getting Started with Capnography,” a one-hour accredited course designed to introduce the benefits of capnography, present a basic understanding of the capnogram, and how to use it to explore the physiology of the respiratory cycle. Visit the EMS1 Academy to learn more and schedule a demo.