Doctors Lounge - Pediatrics Answers
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Forum Name: Pediatric Topics
|elyrmoore - Sat Jan 13, 2007 6:58 pm||
My son is 5.5 years old. He has allergies to animals and a few environmental allergens and has been seen by an allergist atleast once a year. He takes Zyrtec sporadically and until today has had one severe breathing episode that resulted in an ER visit when he was three. This was after being exposed to a dog. Although there is a family history on both sides of Asthma, he has never been diagnosed with asthma.
He came home from pre-school with cold symptoms (including a tight somewhat phlegmy sounding cough) on Thus. and last night went to bed with a slight wheeze. He woke up at 3 AM this morning (Sat) having a lot of breathing trouble. He had a fever of 100.2. I had an inhaler left over from his ER visit at age 3 and gave him to puffs and some Benadryl. After a warm shower, a warm drink and about 30 minutes he got worse. We took him to the ER. Upon arriving his Oxygen sat. was at 92. They gave him 3 brething treatments and one dose of oral Prednisone. A Chest x-ray seemed to show nothing. We left with a prescription for Zythromax and a new inhaler. The Zythromax was for an ear infection and what the doctor considered an upper respiatory infection. After going home and sleeping he woke up in just as bad shape as he was before we went to the ER.
Rather than return to the ER we visited the pediatric office that was covering today for our pediatrician. His Oxygen levels were still at 92. They did one regular breathing treatment and a second one with an inhaled steriod mixed in (primacort). Seconds after the second treatment the nurse took another oxygen level. It stayed at 92 for a minute and then bounced from 93 to 94. We left with a home nebulizer and both the regular breathing treatment and 3 more vials of primacort. We were instructed to do breathing treatments every 4-6 hours, but he has been unable to make it more than two hours. His chest sounds very tight and he occassionaly gets up some clear phlegm, but it hurts him to cough. Is there anything we can give him to loosen his chest? Something like Muscex for kids? Can that cause more harm? The pediatrician has not reuturned our call. Also, should we have insisted on a prednisoone prescription to bring home? We are not used to dealing with breathing problems like this and my husband and I are both concerned about making it through the evening with him. Its so scary to hear him struggle with this. We don't want to unneccisarily bring him back to the ER (which was not the best experience). Any suggestions?
|Dr. Chan Lowe - Sat Jan 13, 2007 11:30 pm||
It sounds as if your child is having a full blown asthma exacerbation. If he is needing albuterol every two hours I would strongly recommend he be evaluated in the emergency room or your pediatrician again.
Children needing albuterol every 2 hours often will need to be admitted to the hospital for close observation. Additionally, an oral steroid burst is likely indicated.
Please do not consider this as a formal recommendation as I cannot evaluate him in person. However, is sounds as if he's fairly sick. Until he can be reevaluated, I would continue the albuterol and pulmicort (the inhaled steroid).
Hope this helps.
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