Croup and Bronchiolitis with Dr. Gabi Hester

Ridgeview Podcast: CME Series

In this podcast, Dr. Gabi Hester, a pediatric hospitalist and Quality Improvement (QI) medical director for Children's Hospitals of Minnesota and St. Luke's Hospital in Duluth. Dr. Hester brings her knowledge and experience in everything related to croup and bronchiolitis (specifically pertaining to in-patients and to frontline healthcare providers).

*Dr. Gabi Hester, speaker for this educational event, has disclosed that she is a consultant who provides content recommendations to AvoMed. All relevant financial relationships for Dr. Hester have been mitigated.

Enjoy the podcast.

Objectives:Upon completion of this podcast, participants should be able to:

• State at least 2 challenges in the recognition of and treatment of acute respiratory illnesses in children.
• Describe potential interventions for bronchiolitis that have not been shown to provide significant benefit to most patients.
• Recognize common "mimickers" of croup.

This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.

CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at [e-mail].

Click the link below, to complete the activity's evaluation.

CME Evaluation

(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT

The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview. Any re-reproduction of any of the materials presented would be infringement of copyright laws.

It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.

None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. All of the relevant financial relationships for the individuals listed above have been mitigated.

Thank-you for listening to the podcast.

SHOW NOTES: *See the attachment for additional information.

PODCAST OVERVIEW

CROUP (layngotracheitis)Overview - 400,000 approx. ER visits/year in U.S. - Costly, approx. $53 million/year - Scary disease due to airway obstruction - Para-influenza most common - Classically, kids are admitted after 2 racemic epinephrine nebulizers - Dr. Hester studied croup and hospitalization (see resources below) - Kids admitted, and no further treatment or intervention (observed) Presentation and treatment - Rhinorrhea, low grade fever, barky cough (seal bark)- Inspiratory stridor, usually worse when agitated - Rarely insp and exp stridor (if progressed disease state) - Dexamethason 0.6 mg/kg (max dose of 12-16 mg) - Nebulized racemic epinephrine (RA) - bridge for steroid to kick in - reserved for stridulous patient - Think about croup mimics - not responding to racemic epinephrine - older kids (i.e. 7 yr old), think about other diagnoses - Epiglottitis - cough is less barky - respiratory distress and tripoding - thumb print sign - Bacterial tracheitis - can be complication of viral croup - can quickly decompensate - Foreign body, airway anomalies, etc. TREATMENT: - cool outdoor air can be soothing, no good studies to support - humidified air - imaging can be done (steeple sign on AP neck) but not routinely required - Worried about foreign body? Epiglottitis? - not responding to racemic epi - CXR if hypoxia. Not typical of croup to be hypoxia.Research (links below) - Most kids don't need further treatment after ED course. -