Blockage of the small airways in the lungs due to a viral infection
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Episode 188: RSV Management and PreventionDr. Sandhu and future Dr. Mohamed summarize the management of RSV and describe how to prevent it with chemoprophylaxis and vaccines. Dr Arreaza adds some comments about RSV vaccines.Written by Abdolhakim Mohamed, MSIV, Ross University School of Medicine. Comments by Ranbir Sandhu, MD, and Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is RSV? -The Respiratory syncytial Virus (RSV) is an enveloped, negative-sense, single-stranded RNA virus of the Orthopneumovirus genus within the Pneumoviridae family. -RSV is a major cause of acute respiratory tract infections, particularly bronchiolitis and pneumonia, in infants and young children, and it also significantly affects older adults and immunocompromised individuals. -RSV infections cause an estimated 58,000–80,000 hospitalizations among children younger than 5 years and 60,000–160,000 hospitalizations among adults older than 65 years each year.-RSV is highly contagious and spreads through respiratory droplets and direct contact with contaminated surfaces. The virus typically causes seasonal epidemics, peaking in the winter months in temperate climates and during the rainy season in tropical regions. -Virtually all children are infected with RSV by the age of two, and reinfections can occur throughout life, often with milder symptoms.-Per the 2014 Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis, from the American Academy of Pediatrics, the most common etiology of bronchiolitis is RSV. -About 97% of children are infected with RSV in the first 2 years of life, about 40% will experience lower respiratory tract infection during the initial infection. Other viruses that cause bronchiolitis include human rhinovirus, human metapneumovirus, influenza, adenovirus, coronavirus, and parainfluenza viruses.When is RSV season?-Classically, the highest incidence of infection occurs between December and March in North America. Per CDC, there were typical prepandemic RSV season patterns, but the COVID-19 pandemic disrupted RSV seasonality during 2020–2022. -Before we dive into the seasonality patterns, for context, in order to describe RSV seasonality in the US, data was gathered and analyzed from polymerase chain reaction (PCR) test results reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS) during July 2017–February 2023. -Seasonal RSV epidemics were defined as the weeks during which the percentage of PCR test results that were positive for RSV was ≥3%. Per 2017–2020 data, RSV epidemics in the United States typically follow seasonal patterns, that began in October, peaked in December or January, and ended in April. -However, during 2020–21, the typical winter RSV epidemic did not occur. The 2021–22 season began in May, peaked in July, and ended in January. -The 2022–23 season started (June) and peaked (November) later than the 2021–22 season, but earlier than prepandemic seasons. CDC notes that the timing of the 2022–23 season suggests that seasonal patterns are returning toward those observed in prepandemic years, however, warn that clinicians should be aware that off-season RSV circulation might continue.Treatment of RSVSome key points of the 2014 pediatric guidelines from the American Academy of Pediatrics.-AAP strongly do not recommend beta agonists or steroids for viral associated bronchiolitis because of no significant improved outcomes. “Clinicians should not administer albuterol (or salbutamol) to infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Strong Recommendation).”-Epinephrine is not recommended for infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Strong Recommendation).-Nebulized hypertonic saline should not be administered to infants with a diagnosis of bronchiolitis in the emergency department (Evidence Quality: B; Recommendation Strength: Moderate Recommendation), but hypertonic saline may be administered when they are hospitalized (Evidence Quality: B; Recommendation Strength: Weak Recommendation [based on randomized controlled trials with inconsistent findings]).-Chest physiotherapy should not be used in infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Moderate Recommendation).-Antibiotics should not be administered in bronchiolitis unless there is a concomitant bacterial infection, or a strong suspicion of one (Evidence Quality: B; Recommendation Strength: Strong Recommendation).-Oxygen therapy may not be administered if the oxyhemoglobin saturation exceeds 90% in infants and children with a diagnosis of bronchiolitis (Evidence Quality: D; Recommendation Strength: Weak Recommendation [based on low level evidence and reasoning from first principles]).-Clinicians should administer nasogastric or intravenous fluids for infants with a diagnosis of bronchiolitis who cannot maintain hydration orally (Evidence Quality: X; Recommendation Strength: Strong Recommendation).How do we prevent RSV?Infant Immuno-prophylaxis:A clinical trial in 2022 demonstrated that a single injection of nirsevimab (Beyfortus®), administered before the RSV season, protected healthy late-preterm and term infants from RSV-associated lower respiratory tract that required medical treatment. Nirsevimab is a monoclonal antibody to the RSV fusion protein that has an extended half-life.Additionally, on August 3, 2023, the Advisory Committee on Immunization Practices (ACIP) recommended nirsevimab for all infants younger than 8 months who are born during or entering their first RSV season and for infants and children between 8-19 months who are at increased risk for severe RSV disease and are entering their second RSV season. On the basis of pre-COVID-19 pandemic patterns, nirsevimab could be administered in most of the continental United States from October through the end of March.Maternal Vaccination: The CDC recommends the administration of the RSVPreF vaccine to pregnant women between 32 0/7 and 36 6/7 weeks of gestation. This vaccination aims to reduce the risk of RSV-associated lower respiratory tract infection in infants during the first 6 months of life.At this time, if a pregnant woman has already received a maternal RSV vaccine during any previous pregnancy, CDC does not recommend another dose of RSV vaccine during subsequent pregnancies.Older individuals: -Each year in the U.S., it is estimated that between 60,000 and 160,000 older adults are hospitalized and between 6,000 and 10,000 die due to RSV infection-ABRYSVO's approval will help offer older adults protection in the RSV season.-On June 26, 2024, ACIP voted to give these recommendations: all adults older than 75 years and adults between 60–74 years who are at increased risk for severe RSV disease should receive a single dose of RSV vaccine (Abrysvo®).Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Hamid S, Winn A, Parikh R, et al. Seasonality of Respiratory Syncytial Virus — United States, 2017–2023. MMWR Morb Mortal Wkly Rep 2023;72:355–361. DOI: http://dx.doi.org/10.15585/mmwr.mm7214a1Hammitt LL, Dagan R, Yuan Y, Baca Cots M, Bosheva M, Madhi SA, Muller WJ, Zar HJ, Brooks D, Grenham A, Wählby Hamrén U, Mankad VS, Ren P, Takas T, Abram ME, Leach A, Griffin MP, Villafana T; MELODY Study Group. Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants. N Engl J Med. 2022 Mar 3;386(9):837-846. doi: 10.1056/NEJMoa2110275. PMID: 35235726.Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S 3rd, Hernandez-Cancio S; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-502. doi: 10.1542/peds.2014-2742. Erratum in: Pediatrics. 2015 Oct;136(4):782. doi: 10.1542/peds.2015-2862. PMID: 25349312.CDC, per their published article Seasonality of Respiratory Syncytial Virus — United States for 2017–2023, in the United StatesWhat U.S. Obstetricians Need to Know About Respiratory Syncytial Virus.Debessai H, Jones JM, Meaney-Delman D, Rasmussen SA. Obstetrics and Gynecology. 2024;143(3):e54-e62. doi:10.1097/AOG.0000000000005492.Maternal Respiratory Syncytial Virus Vaccination and Receipt of Respiratory Syncytial Virus Antibody (Nirsevimab) by Infants Aged
Aubrey speaks to Dr Becky Kgole, Specialist Physician & Pulmonologist, about popcorn lung disease. It’s a serious and irreversible lung disease linked to certain chemicals found in vaping, factory fumes, and even microwave popcorn production. Tonight, on our Medical Matters we explore what exactly popcorn lung is, also known as bronchitis obliterans.See omnystudio.com/listener for privacy information.
The GEL Jr crew back with a topical episode on bronchiolitis. When you scan the lungs of these kids what do you see, and more importantly.... what does it mean?? https://www.ultrasoundgel.org/168 https://pubmed.ncbi.nlm.nih.gov/37897916/
This episode covers bronchiolitis.Written notes can be found at https://zerotofinals.com/paediatrics/respiratory/bronchiolitis/Questions can be found at https://members.zerotofinals.com/Books can be found at https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.
Welcome back to the first Roadside to Resus episode for 2025!! In this episode, we're diving into a seasonally appropriate, and really paediatric common presentation for anyone involved in emergency care….Bronchiolitis. Now although it's one of the most common respiratory illnesses affecting kids, bronchiolitis can easily cause confusion and concern around the severity of illness, whether to convey/admit/discharge, and also which treatments are indicated and which aren't, including the perennially hot topic of bronchodilators. In this episode we're going to and delve into all of those aspects & explore the evidence and guidelines that are out there for bronchiolitis, including the NICE guidelines on the topic. So, whether you're on the frontlines of paediatric emergency medicine or just brushing up on your knowledge, this episode…hopefully…will be packed with practical insights to enhance your care in those patients with bronchiolitis or even the differentials! Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James
How do you know when your child has a cold or the flu or something even more serious?Children regularly pick up coughs and viruses and it can be tricky to understand when to worry, how to soothe symptoms and when to keep your child at home - this week's episode has the answers!We chatted to Dr Lillie Parker, an NHS paediatrician, about winter colds and flu and about the RSV virus which can cause the more serious condition of bronchiolitis. Filled with tips, advice and information, we know this episode will be super helpful and strike a chord with every parent or carer this autumn/winter season! References:Follow and connect with Dr Lils here on InstagramRead the Mini First Aid blog about RSV/bronchiolitis.Find out more from the NHS on Bronchiolitis and read their guide to RSV here.See the NHS guidance and advice on pregnancy and children's vaccinations.Mini First Aid Family First Aid Kit - Platinum Award winning first aid kit, voted a Best Buy in the Loved By Parents Awards 2021, is a comprehensive first aid kit for all the family. Containing 115 essential items, it is ideal for keeping in your car or at home for any first aid emergencies.Find out more about our multi award winning two hour Baby & Child first aid classes here, delivered in a relaxed and comfortable style to give you the confidence to know what actions to take if faced with a medical emergency.For press enquiries and to contact Mini First Aid, email info@minifirstaid.co.ukSeries 4 of the Family Health Podcast by Mini First Aid is sponsored by Things Happen, a trusted broker which offers the best financial advice to help parents and their families make informed decisions, ensuring a secure and tax-efficient future for their children. The team at Things Happen consists of highly qualified financial experts who can guide you through the different types of life insurance policies to consider as your family expands, taking the stress out of decision-making by finding the best deals. If you already have life insurance Things Happen will carefully review your existing policy to ensure it still meets your family's needs, giving you peace of mind, knowing your family is fully protected. And finally, if reviewing your life insurance is still on your to-do list, take time to get in touch with an experienced Things Happen financial advisor today.
Dr Damien Gates talking about Bronchiolitis. This talk is part of the Paediatric Emergencies 2024 event. To get your CME certificate for watching the video please visit https://www.paediatricemergencies.com/conference/paediatric-emergencies-2024/ #PaediatricEmergencies #PaediatricEmergencies2024 #Bronchiolitis
Summaries of both Bronchiolitis and Viral Induced Wheeze featuring the key points, as well as the main differences between them. Includes pathophysiology, symptoms and treatment for each. Consider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 Bronchiolitis Pathophysiology and Causes1:10 Bronchiolitis Symptoms2:25 Bronchiolitis Treatment03:13 Viral Induced Wheeze Pathophysiology and Causes4:02 Viral Induced Wheeze Symptoms5:07 Viral Induced Wheeze Treatment5:44 Important Differentials ReferencesBhatia, R - MSD Manual Pro (2024) - “Bronchiolitis”. Available at https://www.msdmanuals.com/professional/pediatrics/respiratory-disorders-in-young-children/bronchiolitisNICE Clinical Knowledge Summaries (2024) - “Cough - acute with chest signs in children”. Available at https://cks.nice.org.uk/topics/cough-acute-with-chest-signs-in-children/diagnosis/diagnosis-of-cause/Zaininger, P - Geeky Medics (2024) - “Viral Induced Wheeze and Asthma”. Available at https://geekymedics.com/viral-induced-wheeze-and-asthma/Snelson, E - RCEM Learning (2024) - “Coughing, Wheezy and Stridulous Children”. Available at https://www.rcemlearning.co.uk/foamed/coughing-wheezy-and-stridulous-children/Children's Hospital of Philadelphia - “Heart Failure in Children”. Available at https://www.chop.edu/conditions-diseases/heart-failure-childrenPlease remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice.
In this episode, we review the high-yield topic of Bronchiolitis from the Pediatrics section at Medbullets.com Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets
The topic for today's episode is viral Upper respiratory infections, also known as a cold. Join us as we discuss prevention, treatment and how to help your baby feel better when he or she has a cold.
Mike, Jess and Jennifer discuss the case of Aira Salter, a 16 month old who is brought to the office with coughing and wheezing. To claim your Mainpro+ credit for listening to this podcast, click here: https://cfpclearn.ca/podcast/in-the-clinic-episode-20-bronchiolitis/
Host Kyle B. Enfield, MD, FSHEA, FCCM is joined by Danielle K. Maue, MD, to discuss improving outcomes for bronchiolitis patients through a high-flow nasal cannula protocol, as discussed in the Pediatric Critical Care Medicine article, "Improving Outcomes for Bronchiolitis Patients After Implementing a High-Flow Nasal Cannula Holiday and Standardizing Discharge Criteria in a PICU." (Maue DK, et al. Pedtr Crit Care Med. 2023 Mar;24:233-244). Together, they explore groundbreaking initiatives that significantly improved outcomes for bronchiolitis patients using a high-flow nasal cannula protocol, the key interventions, and their impact. Dr. Maue is an Assistant Professor of Clinical Pediatrics for Riley Hospital for Children at Indiana University in Indianapolis, Indiana.
At the peak of respiratory virus season, bronchiolitis is one of the most common presentations in infants and young toddlers. The characteristic wheeze and prolonged duration of illness can be distressing for parents, who may lack the practical knowledge of how to effectively implement supportive care. When the mainstay of treatment is supportive care without any single curative intervention, you need to be able to discuss the etiology, management, and anticipatory guidance on a level that the parents can understand. This episode introduces the idea of capacity-building family-centered care and takes a granular, detailed approach to improving family understanding and home care education so that you can facilitate better evidence-based care in the unrestricted environment of the home. By arming parents with the knowledge and skills needed to care for their infant at home and the clear, objective return criteria, you're providing family-centered care and reducing unnecessary visits. Instagram: @thepedsnppodcast Show notes and references thepedsnp.com Disclaimer References Justice NA, Le JK. Bronchiolitis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441959/ Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611 Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120
Hosts:Pradip Kamat, Children's Healthcare of Atlanta/Emory University School of MedicineRahul Damania, Cleveland Clinic Children's HospitalIntroductionToday, we discuss the case of an 8-month-old infant with severe bronchospasm and abnormal blood gas. We'll delve into the epidemiology, pathophysiology, and evidence-based management of acute bronchiolitis.Case SummaryAn 8-month-old infant presented to the ER with decreased alertness following worsening work of breathing, preceded by URI symptoms. The infant was intubated and transferred to the PICU, testing positive for RSV. Initial blood gas showed 6.8/125/-4, and CXR revealed massive hyperinflation. Vitals: HR 180, BP 75/45, SPO2 92% on 100% FIO2, RR 12 (prior to intubation), now around 16 on the ventilator, afebrile.Discussion PointsEtiology & Pathogenesis: Bronchiolitis is primarily caused by RSV, with other viruses and bacteria playing a role. RSV bronchiolitis is the most common cause of hospitalization in infants, particularly in winter months. Immuno-pathology involves an unbalanced immune response and can lead to various extra-pulmonary manifestations.Diagnosis: Diagnosis is clinical, based on history and examination. Key signs include upper respiratory symptoms followed by lower respiratory distress. Blood gas, chest radiography, and viral testing are generally not recommended unless warranted by severe symptoms or clinical deterioration.Management Framework: For patients requiring PICU admission, focus on oxygenation and hydration. High-flow therapy and nasal continuous positive airway pressure (CPAP) can be used. Hydration and feeding support are crucial. Antibiotics, steroids, and bronchodilators are generally not recommended. Mechanical ventilation and ECMO may be necessary in severe cases.Immunoprophylaxis & Nosocomial Infection Prevention: Palivizumab and nirsevimab are used for RSV prevention in high-risk infants. Strict infection control measures, including hand hygiene and isolation, are essential to prevent nosocomial infections.ConclusionRSV bronchiolitis is a common and potentially severe respiratory illness in infants. Management focuses on supportive care, with a careful balance between oxygenation and hydration. Immunoprophylaxis and infection control are crucial in preventing the spread of the virus.Thank you for listening to our episode on acute bronchiolitis. Please subscribe, share your feedback, and visit our website at picudoconcall.org for more resources. Stay tuned for our next episode!ReferencesRogers - Textbook of Pediatric Critical Care Chapter 49: Pneumonia and Bronchiolitis. De Carvalho et al. page 797-823Reference 1: Dalziel, Stuart R; Haskell, Libby; O'Brien, Sharon; Borland, Meredith L; Plint, Amy C; Babl, Franz E; Oakley, Ed. Bronchiolitis. The Lancet. , 2022, Vol.400(10349), p.392-406. DOI: 10.1016/S0140-6736(22)01016-9; PMID:...
In today's episode Drs Hare, Jeffers, and Samuel discuss RSV bronchiolitis, the new RSV vaccination, and cold weather safety for kids! Time Stamps: RSV Bronchiolitis - 1:38 Health News - 7:00 Parenting Tips for Cold Weather - 8:34 Trivia - 11:00
Contributor: Ricky Dhaliwal, MD Educational Pearls: Croup Caused by: Parainfluenza, Adenovirus, RSV, Enterovirus (big right now) Age range: 6 months to 3 years Symptoms: Barky cough Inspiratory stridor (Severe = stidor at rest) Use the Westley Croup Score to gauge the severity Treatment: High flow, humidified, cool oxygen Dexamethasone 0.6 mg/kg oral, max 16mg Severe: Racemic Epinephrine 0.5 mL/kg Consider heliox, a mixture of helium and oxygen Very severe: be ready to intubate Bronchiolitis Caused by: RSV, Rhinovirus Symptoms are driven by secretions Symptoms: Cough Wheezing Dehydration (often the symptom that makes them look the worst) Age range: 2 to 6 months Treatment: Suctioning Oxygen IV fluids Nebulized hypertonic saline DuoNebs? No. Asthma Caused by: Environmental factors Viral illness with a predisposition Treatment: Beta agonists Steroids Ipratropium Magnesium (relaxes smooth muscle) References Dalziel SR, Haskell L, O'Brien S, Borland ML, Plint AC, Babl FE, Oakley E. Bronchiolitis. Lancet. 2022 Jul 30;400(10349):392-406. doi: 10.1016/S0140-6736(22)01016-9. Epub 2022 Jul 1. PMID: 35785792. Hoch HE, Houin PR, Stillwell PC. Asthma in Children: A Brief Review for Primary Care Providers. Pediatr Ann. 2019 Mar 1;48(3):e103-e109. doi: 10.3928/19382359-20190219-01. PMID: 30874817. Midulla F, Petrarca L, Frassanito A, Di Mattia G, Zicari AM, Nenna R. Bronchiolitis clinics and medical treatment. Minerva Pediatr. 2018 Dec;70(6):600-611. doi: 10.23736/S0026-4946.18.05334-3. Epub 2018 Oct 18. PMID: 30334624. Smith DK, McDermott AJ, Sullivan JF. Croup: Diagnosis and Management. Am Fam Physician. 2018 May 1;97(9):575-580. PMID: 29763253. Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child. 1978 May;132(5):484-7. doi: 10.1001/archpedi.1978.02120300044008. PMID: 347921. https://www.mdcalc.com/calc/677/westley-croup-score Summarized by Jeffrey Olson | Edited by Meg Joyce & Jorge Chalit, OMSII
Join Dr. Kyle Lemley, a pediatrician at Monument Health in Rapid City, as we tackle the timely topic of bronchiolitis and its challenges amid the ongoing triple pandemic of COVID-19, influenza, and RSV.What is bronchiolitis? It's a common respiratory infection that inflames the small airways in the lungs, primarily affecting infants and young children. While usually mild, it can be especially worrisome for this vulnerable age group.Why is bronchiolitis concerning during the triple pandemic? The overlap in symptoms between these viruses makes diagnosis tricky, putting additional strain on healthcare systems already navigating COVID-19. We'll dive into:Early signs and symptoms of bronchiolitis to be aware of in your little ones.Distinguishing bronchiolitis from other respiratory illnesses, including the current viral culprits.Practical tips for managing bronchiolitis at home and knowing when to seek medical attention.Strategies for protecting your child from these circulating viruses during the triple pandemic.Dr. Lemley will answer your questions and clear up any confusion surrounding bronchiolitis and the current respiratory landscape. So, tune in and breathe easier, Rapid City! Hosted on Acast. See acast.com/privacy for more information.
Nirsevimab is the new FDA-approved monoclonal antibody RSV vaccine for the prevention of severe lower respiratory illness in infants. In this episode, we discuss the current recommendations on who gets the vaccine and when, how to use a lens of health equity to approach the current vaccine shortages, and how to discuss safety and efficacy with vaccine hesitant parents. Now that nirsevimab is on the routine infant immunization schedule, it's extremely important and pediatric providers understand the recommendations and science behind the monoclonal antibody to help vaccine acceptance that will undoubtedly reduce bronchiolitis hospitalization. Instagram: @thepedsnppodcast Show notes and references thepedsnp.com Disclaimer References: CDC Health Alert Network. (2023). Limited availability of nirsevimab in the United States—Interim CDC recommendations to protect infants from Respiratory Syncytial Virus (RSV) during the 2023–2024 respiratory virus season. Emergency Preparedness and Response. https://emergency.cdc.gov/han/2023/han00499.asp?c Centers for Disease Control and Prevention. (2023). Frequently asked questions about RSV immunization with monoclonal antibody for children 19 months and younger. Vaccines and Preventable Diseases. https://www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html Centers for Disease Control and Prevention. (2022). Vaccines for Children Program. https://www.cdc.gov/vaccines/programs/vfc/index.html Centers for Disease Control and Prevention. (2023). General best practice guidelines for immunization. Vaccine Recommendations and the Guidelines of the ACIP. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html Jones, J. M., Fleming-Dutra, K. E., Prill, M. M., Roper, L. E., Brooks, O., Sánchez, P. J., Kotton, C. N., Mahon, B. E., Meyer, S., Long, S. S., & McMorrow, M. L. (2023). Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. Morbidity and mortality weekly report, 72(34), 920–925. https://doi.org/10.15585/mmwr.mm7234a4 Hill, D., & Parga-Belinkie, J. (Host). (2023, August 29). Immunizations special: RSV, Covid, pneumococcal disease, influenza (No. 170) [Audio podcast episode]. In Pediatrics on call. American Academy of Pediatrics. www.aap.org/podcast Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611 Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120
In this podcast, Dr. Gabi Hester, a pediatric hospitalist and Quality Improvement (QI) medical director for Children's Hospitals of Minnesota in Duluth, 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 signigicant 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 Education@ridgeviewmedical.org. 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. -
Pediatrician Dr. Jill Schaffeld consults Dr. Michelle Parker and Dr. Laura Piper on common fall and winter illnesses - Bronchiolitis, Croup, and Influenza - management of these conditions plus ED referral or direct admit. Episode recorded on September 21, 2023. CME & MOC Part 2 We are proud to offer CME and MOC Part 2 from Cincinnati Children's. Credit is free and registration is required. Please click here to claim CME credit via the post-test under "Launch Activity." Resources discussed in this episode: Community Practice Support Tools
In this podcast, JPEN Editor-in-Chief Dr. Kenneth Christopher, interviews Dr. Sabrina Huq, a Pediatric Intensivist at Beaumont Hospital in Royal Oak, Michigan and first author of “Association between goal nutrition and intubation in patients with bronchiolitis on non-invasive ventilation: A retrospective cohort study” published in the January 2024 issue of JPEN. Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US January 2024
Respiratory Syncytial Virus RSV is a 150 nanometer RNA virus that comes from a human orthopneumovirus that circulates in the winter primarily. Young children and infants infected with RSV mostly have upper respiratory tract symptoms where a subset develop lower respiratory tract disease known as bronchiolitis with the primary infection. It is the most common reason for hospitalization in infants between 0 and 6 months of age. Bronchiolitis appears as a wheezy, cough centric illness that rarely may progress to increased respiratory effort noted by wheezing, rales (lung crackles - sounds like stepping on leaves), chest wall rib retractions, grunting, fast breathing, nasal flaring and eventually respiratory hypoxia. If it persists, the event can rarely lead to respiratory collapse and death. Annually, 150 children under 5 years of age die from RSV in the US. Most of these children are premature births and have cardiopulmonary disease issues. Term healthy children rarely succumb to RSV in a serious way. A recent study of German infants and children hospitalized with RSV identified these risk factors: age
1. Review bronchiolitis pathophysiology and epidemiology.2. Discuss the 2014 clinical guidelines on bronchiolitis.3. Describe de-implementation strategies and projects related to bronchiolitis management.
Music: Spark Of Inspiration by Shane Ivers - https://www.silvermansound.comLicensed under Creative Commons Attribution 4.0 International Licensehttps://creativecommons.org/licenses/by/4.0/Music promoted by https://www.chosic.com
ProspectiveDoctor | Helping you achieve your medical school dreams | AMCAS | MCAT
Dr. Erkeda DeRouen talks to Dr. Gary Epler, an internationally-known Harvard Medical School professor and the CEO of Epler Health. They talk about Dr. Epler's discovery of Bronchiolitis obliterans organizing pneumonia, and lessons medical students can take away from his journey. [01:00] Introducing Dr. Gary Epler [04:31] Go to Medical School for the Right Reasons [10:16] Discovering Epler's Pneumonia [15:58] Innovation in Medicine [22:38] Think from the Heart Dr. Gary Epler's Medical Journey The decision to go into medicine is going to be different for each person. Dr. Epler was inspired to become a physician so he can improve patients' lives. His journey had a rough start, with his application rejected by several medical schools. But with enough perseverance, he was able to enter Tulane University's School of Medicine. The life of a medical student is full of challenges, but Dr. Epler faced those head on because he was eager to learn. During his pulmonary critical care training, Dr. Epler took up an interest in bronchitis obliterans. He examined dozens of cases and found abnormalities in the x-rays. After convincing his professor for months, they discovered bronchiolitis obliterans organizing pneumonia and published their findings in the New England Journal of Medicine. Be Your True Self in Medicine Going into medicine for external reasons is not wrong, but internal motivation will better inspire you to provide the best care possible. Dedicated physicians prioritize patients' well-being, even if it means experiencing inconvenience. When we think about ourselves less, the more authentic we can be in our interactions with other people. We become free to innovate and explore creative solutions that will help medicine progress even further. You can reach Dr. Gary Epler through his email at garyepler@gmail.com. Check out his website for more details about his work and podcast. To learn more about how MedSchoolCoach can help you along your medical school journey, visit us at Prospective Doctor. You can also reach us through our social media: Facebook: https://www.facebook.com/MedSchoolCoach Dr. Erkeda's Instagram: https://www.instagram.com/doctordgram/ YouTube: www.youtube.com/@ProspectiveDoctor
Rhinoviren, Bronchiolitis oder Keuchhusten. Bei Atemwegserkrankungen geht die Saison los. Prof. Kekulé gibt einen Überblick, welche Erkrankungen es gibt und worauf Eltern achten sollten.
Rhinoviren, Bronchiolitis oder Keuchhusten. Bei Atemwegserkrankungen geht die Saison los. Prof. Kekulé gibt einen Überblick, welche Erkrankungen es gibt und worauf Eltern achten sollten.
Today's episode features Dr Michael Hochman,to discuss the newly approved FDA product to prevent RSV in children, Nirsevimab (sold under the brand name Beyfortus). Recently there have been two RSV vaccines approved for adults—one for individuals over 60 years old, and one for use in pregnancy to prevent RSV in infants. On today's podcast, the conversation will focus on Nirsevimab, a shot that has been approved by the FDA for all babies up to 8 months old and a second shot for infants up to 19 months who are considered to be at high risk of severe RSV infection. Nirsevimab is a monoclonal antibody with activity againast respiratory syncytial virus (RSV). On today's podcast we will review the benefits and potential side effects of Nirsevimab.Dr Michael Hochman is a Harvard Medical School graduate, a Robert Wood Johnson Clinical Scholars Fellow at UCLA where he received his masters in public health, and he is the founding editor of a book series called “ 50 studies every doctor should know”, so he has a keen interest in reviewing medical studies. Get matched with a therapist by using Better Help! Give it a try---invest in your mental health: https://betterhelp.com/askdrjessica for 10% off your first month of therapy. Thank you to Better Help for supporting the Ask Dr Jessica podcast.Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner. Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com. Dr Jessica Hochman is also on social media:Follow her on Instagram: @AskDrJessicaSubscribe to her YouTube channel! Ask Dr JessicaSubscribe to this podcast: Ask Dr JessicaSubscribe to her mailing list: www.askdrjessicamd.comThe information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.
For most children with children with bronchiolitis, croup, asthma, or first-time wheezing chest X-Rays are not necessary. These X-Rays are often obtained due to the possibility of missing pneumonia. But, these radiographs are hard to interpret, increase length of stay and the cost of care, and expose children to excess radiation. This podcast episode is […]
Course: Corticosteroids for Bronchiolitis? - A Conversation with an Intensivist Course Director: Tony R Tarchichi MD - Associate Professor in Dept of Pediatrics at the University of Pittsburgh School of Medicine Course Director: Jonathan Pelletier MD - Associate Professor of Pediatrics at the Northeast Ohio Medical University This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children. This episode is Corticosteroids for Bronchiolitis? - A Conversation with an Intensivist. As always there is free CME credit of up to 1 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below. ______________________________________________________ Objectives: Upon completion of this activity, participants will be able to: 1. Review how the PICU will use steroids for bronchiolitis. 2. Review why the PICU will use steroids for bronchiolitis. 3. Review the evidence for and against steroids for bronchiolitis. ______________________________________________________ Released: 5/26/2023, Reviewed 5/26/2023, Expire: 5/26/2024 If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account: Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training: Step 2. To access the test for CME credit: Coming Soon! Accreditation Statement: In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The University of Pittsburgh School of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
Review clinical pathways for pneumonia & bronchiolitis.Discuss latest approaches for diagnosing community acquired pneumonia and viral bronchiolitis.
There aren't many couples who can say they both know what it's like to give birth. Former AFLW player, Survivor contestant and author Moana Hope and her wife model Isabella Carlstrom have each been through pregnancy and birth, though they were very different experiences. Moana and Isabella talk to Dr Golly about the impact of childhood trauma on their lives as parents, and how their unique understanding of birth helped them overcome it. LINKS: https://www.rch.org.au/kidsinfo/fact_sheets/Bronchiolitis/ https://birthtrauma.org.au/ See omnystudio.com/listener for privacy information.
Noninvasive respiratory support is an important modality utilized in the pediatric critical care setting to treat respiratory failure without the use of an artificial airway. On today's discussion, pediatric critical care fellow, Dr. John-David Bruce joins pediatric hospitalist, Dr. Brynn Ehlers and Dr. Gene Fisher who is a pediatric intensivist that serves as the division chief of Pediatric Critical Care unit at the Children's Hospital of Georgia. After listening to this podcast, learners should be able to: 1. Recognize different types of noninvasive respiratory support 2. Have an understanding of basic settings involved in the different modes of noninvasive respiratory support 3. Discuss conditions that are most ideal for noninvasive respiratory support 4. Recognize when it is necessary to escalate to a higher mode of respiratory support 5. Common complications of noninvasive respiratory support and how do you treat them. FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19507 References: Amin, R, & Arca, MJ. Feasibility of non-invasive neurally adjusted ventilator assist after congenital diaphragmatic hernia repair. Journal of Pediatric Surgery, 2019;54(3):434-438. Coletti, KD, Bagdure, DN, Walker, LK, Remy, KE, & Custer, JW. High-flow nasal cannula utilization in pediatric critical care. Respiratory Care, 2017;62(8):1023-1029. Desai, JP, & Moustarah, F. Pulmonary Compliance. StatPearls Publishing. 2021. https://www.ncbi.nlm.nih.gov/books/NBK538324/ Fedor, KL. Noninvasive respiratory support in infants and children. Respiratory Care, 2017;62(6):699-717. Franklin, D, Babl, FE, & Schlapbach, LJ, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. The New England Journal of Medicine, 2018;378:1121-1131. Intagliata, S, Rizzo, A, & Gossman, WG. Physiology, Lung Dead Space. StatPearls Publishing. 2020. https://www.ncbi.nlm.nih.gov/books/NBK482501/ Morrison, WE, Nelson McMillan, KL, & Shaffner, DH. (Eds.). Roger's Handbook of Pediatric Intensive Care (5th ed.). 2017. Wolters Kluwer. Najaf-Zadeh A, & Leclerc F. Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review. Ann Intensive Care. 2011;1(1):15. doi:10.1186/2110-5820-1-15 Oymar, K, & Bardsen, K. Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study. BMC Pediatrics. 2014;14:122. Pope, JF, & Birnkrant, DJ. Noninvasive ventilation to facilitate extubation in a pediatric intensive care unit. Journal of Intensive Care Medicine. 2000;15(2):99-103. Storre, JH, Bohm, P, Dreher, M, & Windisch, W. Clinical impact of leak compensation during non-invasive ventilation. Respiratory Medicine. 2009;103(10):1477-1483. Silver AH, Nazif JM. Bronchiolitis. Pediatr Rev. 2019;40(11):568-576. doi:10.1542/pir.2018-0260
In this episode, Angela Branche, MD, and Helen Y. Chu, MD, MPH, discuss the impact of respiratory syncytial virus (RSV) and describe those at risk for severe RSV disease, including: RSV prevalence and seasonality RSV burden throughout life, including burden in older adultsComorbidities that increase the risk of RSV complications RSV transmission in the hospital and care home settingImplications of risk factors for severe RSV on prevention and treatment Faculty: Angela Branche, MDAssociate Professor of MedicineDivision of Infectious DiseasesDepartment of MedicineUniversity of RochesterRochester, New YorkHelen Y. Chu, MD, MPHAssociate Professor of MedicineDivision of Allergy & Infectious DiseasesUniversity of Washington School of MedicineSeattle, WashingtonLink to full program: bit.ly/3nb25xeLink to downloadable slides: bit.ly/3TsXym5
$5 Q-BANK: https://www.patreon.com/highyieldfamilymedicine Intro 0:30, Asthma 1:29, COPD 7:50, Pulmonary function tests 13:03, Interstitial lung disease 16:23, Pneumonia 21:09, Tuberculosis 27:55, Fungal lung infections 32:03, Bronchiolitis 34:14, Acute bronchitis 35:14, Stridor 36:06, Croup 36:57, Foreign body aspiration 37:30, Epiglottits 39:38, Anaphylaxis 40:12, Angioedema 41:40, Nasopharyngeal obstructions 42:39, Lung cancer 45:05, Pulmonary embolism 47:43, Pneumothorax 51:00, Pleural effusion 54:09, Congestive heart failure and pulmonary edema 57:20, Non-cardiogenic pulmonary edema 1:01:38, Pulmonary hypertension 1:05:07, Honorable mentions 1:08:04, Practice questions, 01:10:42
Course: Albuterol for Bronchiolitis? - A Conversation with an Intenstivist Course Director: Tony R Tarchichi MD - Associate Professor in Dept of Pediatrics at the University of Pittsburgh School of Medicine Course Director: Jonathan Pelletier MD - Associate Professor of Pediatrics at the Northeast Ohio Medical University This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children. This episode is Albuterol for Bronchiolitis? - A Conversation with an Intenstivist. As always there is free CME credit of up to 1 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below. ______________________________________________________ Objectives: Upon completion of this activity, participants will be able to: 1. Discuss the increase in albuterol usage for bronchiolitis occurring in pediatric intensive care units nationally. 2. Discuss the evidence base behind using albuterol for bronchiolitis in critically ill pediatric patients. 3. Discuss how the American Academy of Pediatrics bronchiolitis guidelines apply to the patients in the pediatric intensive care units. ______________________________________________________ Released: 3/13/2023, Reviewed 3/13/2023, Expire: 3/13/2024 If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account: Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training: Step 2. To access the test for CME credit: Coming Soon!!! Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this enduring material for a maximum of (1) AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Bronchiolitis is a common lung infection in young children and infants. Approximately one-tenth of the affected children are admitted, and between 2 and 6% of them present a severe form and are referred to paediatric intensive care units. Nevertheless, the definition of severe acute bronchiolitis is mainly clinical and based on low levels of evidence.In this podcast, Dr Milési presents guidelines for managing infants under 12 months of age with severe bronchiolitis to create a series of pragmatic recommendations for a patient subgroup poorly individualised in national and international guidelines. Original paper: Clinical practice guidelines: management of severe bronchiolitis in infants under 12 months old admitted to a paediatric critical care unitSpeakersChristophe MILÉSI. Pediatric Intensive Care Unit, Montpellier University Hospital (FR).Mariangela PELLEGRINI. Dept. of Surgical Sciences, Uppsala University (SE).
WEBSITE: NCLEXHIGHYIELD.COM OUR ENTIRE COURSE IS NOW ON DEMAND! No matter where you are in the world, or what your schedule is like, access the entire course RAW AND UNCUT at www.NCLEXHighYieldCourse.com The NCLEX High Yield Podcast was featured on Top 15 NCLEX Podcasts! Make sure you JOIN OUR NEW VIP FACEBOOK GROUP! https://nclexhighyield.com/blogs/news/nclex-high-yield-quick-links A topic that confuses many, but listen to how Dr. Zeeshan breaks this bad boy down! Many people get overwhelmed with all the information that's out there, we keep it simple! Join us weekly for FREE Zoom Sessions and be one of the many REPEAT test takers that passed the exam by spending NO MONEY with NCLEX High Yield! NCLEX High Yield is a Prep Course and Tutoring Company started by Dr. Zeeshan in order to help people pass the NCLEX, whether it's the first time , or like the majority of our students, it's NOT their first time. We keep things simple, show you trends and tips that no one has discovered, and help you on all levels of the exam! Follow us on Instagram: @NCLEXHighYield or check out our website www.NCLEXHighYield.com Make sure you join us for our FREE Weekly Zoom Sessions! Every Wednesday 3PM PST / 6PM EST. The link is in out Instagram Bio, or email contact@nclexhighyield.com to be added to our list. --- Support this podcast: https://anchor.fm/nclexhighyield/support
In this main episode podcast Anton discusses with world expert and bronchiolitis researcher Dr. Suzanne Schuh, the challenges of the diagnosis and management of bronchiolitis during a time of crisis in pediatric emergency medicine and offers some evidence-based solutions to improving outcomes while minimizing valuable resources, as part of our 'Best of University of Toronto EM' series... The post Ep 177 Bronchiolitis – Diagnostic Challenges and Management Pitfalls appeared first on Emergency Medicine Cases.
In this episode, we chat with Melissa Verseman of Beyond The BVM about the current overwhelming state of pediatric respiratory illnesses in Colorado, and Nationwide, and the proper approach to managing pediatric patients with critical RSV and Bronchiolitis.Melissa shares with us her Pearls of managing the patient with RSV:Nasotracheal SuctioningFluid Boluses (20ml/kg x 3)Utilization of Positive End Expiratory Pressure (PEEP) to stint open airways.Maximum flow of High Flow Nasal Cannula / Nasal CPAP should be 1liter/kg or 10 liters per min before escalating care to mask BiPapConsider your pediatric assessment triangle and be quick to recognize a patient who's in cardiorespiratory shock.Links mentioned in this podcastPeds SCUBA Mask - Full Face Pediatric BPap MaskPediatric Assessment TriangleMelissa can be contacted at www.beyondthebvm.com.Support the showMedic and RN CE's available over at academy.flightcrit.com
We are now halfway through the month and the clock is definitely ticking. In fact, there is only 12.3 percent left for 2022 in the remaining month and a half. This is another regular installment of Charlottesville Community Engagement, a newsletter and podcast that seeks to be published as often as is necessary. I'm your host, Sean Tubbs, an award winning journalist and freelance member of the Virginia Press Association. On today's program:* Continuing updates on the murder of three members of the University of Virginia football team. Two other people remain hospitalized. * Concern continues to mount about the convergence of flu season with the presence of RSV as well as the background of the continuously evolving COVID virus* A new round-about opens tomorrow at the intersection of U.S. 250 and Route 151 in Albemarle County * Charlottesville gets funding to acquire property across Moores Creek from Azalea Park for a new alignment of the Rivanna Trail* Delegate Sally Hudson briefs the Albemarle Board of Supervisors on ranked-choice voting To get each newsletter in your inbox, please sign-up. If you like the program, please consider paying through Substack. That'll help me be ready to report whenever its necessary.Today's first shout-out: LEAP wants to help you prepare for winterCrisp air and colorful leaves. Hot cocoa. Snow days. There are plenty of reasons to get excited about fall and winter, but the return of high heating bills isn't one of them. Your local energy nonprofit, LEAP, has been empowering Virginians with energy efficiency and solar solutions since 2010. With programs for all income levels, residents can access upgrades like insulation, LED bulbs, low-flow fixtures, and affordable rooftop solar systems. Visit www.leap-va.org to learn more, and fill out the LEAP Services Inquiry form to lower high heating bills and stay cozy this winter. UVA community continues to mourn murder victims Last night, hundreds if not thousands of people filled the Lawn at the University of Virginia to mourn the murder of three students murdered Sunday night. Classes at the University of Virginia are not in session today for a second day of mourning for the deaths of Devin Chandler, Lavel Davis Jr, and D'Sean Perry.All three were members of the football team. Coach Tony Elliott posted a message across social media. A fourth student has not been identified officially, but the Cavalier Daily and others are reporting a tweet from someone believed to be the mother of one of the two who were injured.For more on the story, do take a look at other accounts:* ‘Wonderful People': UVA Community Pays Tribute to Lost Student-Athletes, Andrew Ramspacher, UVA Today, November 14, 2022* "I'm not sure if I have the right words yet": UVa students react to Sunday night shooting, Sidney Shuler and Alice Berry, Daily Progress, November 14, 2022* Suspect in Sunday's shooting taken into custody, Ava MacBlane, Cavalier Daily, November 14, 2022* Mike Hollins, one of two students injured Sunday evening, undergoes second surgery, Eva Surovell and Ava MacBlane, Cavalier Daily, November 15, 2022Around the same time the lockdown at the University of Virginia was lifted, Charlottesville police and UVA police began work on investigating a series of social media posts that made threats against UVA. “CPD opened an investigation into the postings and the individual believed to be responsible for posting them,” reads a press release. “At approximately 4:00 p.m., Charlottesville detectives obtained and subsequently served a search warrant for an address associated with the suspect in the 200 block of West Main Street in the City of Charlottesville.”They then arrested 31-year-old Bryan Michael Silva and charged him with weapons possession by a felon and possession of a controlled substance. Silva rose to fame as an internet personality whose armed standoff with Charlottesville Police resulted in a previous jail sentence.At this time, CPD does not believe at this time Mr. Silva's threats were related to the tragic events that occurred last night at the University of Virginia. However, we understand the fear this caused in our community and acted swiftly to resolve this investigation.He is being held without bond at the Albemarle-Charlottesville Regional Jail. As for shooting suspect Christopher Darnell Jones Jr., he is expected to be held be arraigned tomorrow in Albemarle County court as the University of Virginia is technically within that jurisdiction. Pediatricians keeping an eye on RSV casesThe colder weather this week comes at a time when flu cases are rising across the country and while respiratory syncytial virus or RSV is peaking. RSV is something most people are expected to get at some point when they are children. “And adults get RSV too,” said Dr. Debbie-Ann Shirley is an infectious disease expert at UVA Children's Hospital. “It tends to be more severe at the extremes of age so very young children and the elderly can develop more severe RSV. In young children, that can look like a pneumonia or bronchiolitis.” Bronchiolitis is the inflammation of the small airways in the lung according to the Centers for Disease Control. Dr. Shirley said this has resulted in more hospitalizations of children to assist them with breathing.“There is not currently a good RSV treatment like an antiviral and there's not currently a vaccine available,” Dr. Shirley said. “However, for select very high-risk infants, there a monoclonal antibody that can be given monthly as an injection throughout RSV season.”Dr. Shirley said that before the pandemic, RSV was fairly predictable with rises expected in fall with a winter peak before subsiding in the warmer months with almost no cases. But that changed in the year of the shutdown. “First, a complete disappearance of RSV and we didn't see the typical peak during the fall of 2020 and into the winter of 2021 and then we started to see an interseasonal out-of-season spread,” Dr. Shirley said. “So RSV has become very unpredictable and this season we saw a very early and rapid peak in RSV cases.”Dr. Shirley said that meant between ten and a dozen new patients admitted each day for RSV, and that number had dropped slightly as of last week. The situation may be worse because many children born during the pandemic did not have had regular exposure. “We're not yet able to breath any sigh of relief, one because we don't know how long or how sustained this current peak will be, and two because we are really starting to see an uptick in flu including severe flu in children being admitted with the flu.” Dr. Shirley said it is important to take a COVID test when symptoms present themselves to rule that out. She also urged the importance of wearing a face mask to limit transmission and isolating when ill. One of her colleagues added this advice. “Most importantly, if you're feeling sick, stay at home and don't spread illness to others,” said Dr. Costi Sifri, the director of hospital epidemiology for UVA Health. “And we really can't emphasize enough that now is the time to get your flu vaccine.” Sifri said this is also a good time to get a bivalent COVID vaccine if you have not already done so. The Virginia Department of Health today reports a seven-day average of 891 new cases. That trend has been declining since the end of the summer. New roundabout to open at U.S. 250 / Route 151A new traffic pattern will begin tomorrow at the intersection of U.S. 250 and Route 151 in Nelson County. The Virginia Department of Transportation expects that vehicles will be routed through a new roundabout beginning at 9 a.m. "Flaggers will control traffic through the intersection while the traffic signals at the intersection are removed and pavement striping is completed,” reads a VDOT press release. “Drivers should anticipate brief delays during traffic stoppages and congestion in the vicinity of the project. The traffic switch will be complete, and the flagging operation removed by 3 p.m., at which time traffic will use the roundabout for all movements through the intersection."This will not be the end of construction, however. Work will continue outside the travel way until February. This project is one of six being built by Curtis Contracting under a $28.5 million contract. Another is the diverging diamond at U.S. 250 and Interstate 64. That project opened to traffic this past weekend. The four completed projects are the reconfiguration of I-64's Exit 118 to add a traffic light on U.S. 29 to access to eastbound I-64, a roundabout at Route 20 and Proffit Road, a connector road between Rio Mills Road and Berkmar Drive, and a second turn lane from northbound U.S. 29 onto Fontaine Avenue into Charlottesville. All six were funded through VDOT's Smart Scale process. Charlottesville receives funding to buy land along Moores Creek The Virginia Land Conservation Foundation has awarded nearly $15 million in grants across the Commonwealth to help preserve land from development. That includes $175,000 for Charlottesville to purchase 8.6 acres of land in Albemarle County along Moores Creek. That falls under the “Open Spaces and Parks” category of the program. The money can be used to purchase property, acquire conservation easements, or some other method of preserving land. In this case, Charlottesville will use the funding to buy land currently used by the International Rescue Committee for an urban farming project. That use would continue. “This property is a priority for developing the Moores Creek Greenway as it allows a shared use path and the [Rivanna Trail] to stay on the same side of Moores Creek as the trail upstream and means we don't absolutely have to build a bridge, which could cost as much or more than the land itself,” said parks planner Chris Gensic in response to a question. Gensic said Albemarle County is aware of the potential purchase and have made comments related to is compliant with the county Comprehensive Plan. Other project in the area also received funding:* The Nature Conservancy will get $71,937 for 179 acres at Gent Branch in the Elk Conservation Area. * The Piedmont Environmental Council will get $500,000 for farmland protection along Brook Run covering about 698 acres in Culpeper County. * The Piedmont Environmental Council will also get $237,500 for farmland protection on about 340 acres in Orange County. Click here for the full list. Standard disclaimer rules apply: PEC is a sponsor of the Week Ahead newsletter but have no editorial control over or involvement with my workSecond Shout-out is for the Charlottesville Area Tree Stewards In today's second subscriber-supported shout-out, an area nonprofit wants you to know about what they offer to help you learn how to preserve, protect, and appreciate! The Charlottesville Area Tree Stewards holds several events throughout the year including a walk in western Albemarle County on the morning of November 20 through a well preserved and highly diverse woodland to see naturally occurring winterberry, spicebush, and dogwood laden with red berries. In abundance will be nuts from forest oaks, hickories, walnuts as well as orchard grown Chinese chestnuts, walnuts, pecans, and American hazelnuts. Registration is limited. Want to know more about how to identify non-native plants so you can help get rid of them over the winter? There's a two-part class that begins December 7. Visit charlottesvilleareatreestewards.org for more information. Albemarle Supervisors exploring ranked-choice voting Tomorrow the Albemarle Board of Supervisors will discuss what the Electoral Board might need if a directive was given to adopt an alternative method of selecting candidates. Earlier this month, Delegate Sally Hudson (D-57) briefed the elected officials with control over elections policy on what's known as ranked choice voting. “Ranked choice voting is an election reform that is now being adopted across the country, both coasts and every in between,” Hudson said. Hudson said ranked choice would encourage participation both by voters and by candidates who might feel they have a better chance of making the ballot. She also said this method would elect people who can build consensus. “Consensus builders who are invested in the very real work of bringing people together to get good governing done,” Hudson said. “That's what has motivated me to be so passionate about this topic for some years now.”Under ranked choice voting, people select more than one candidate.“You get to rank the candidates from most to least favorable,” Hudson said. Hudson said the state of Maine has been using ranked-choice voting since 2018. There's a whole list of Frequently Asked Questions about the process there. In many cases, there are still only two candidates for a particular office. “But in the event that more than two candidates run, the ranked choice voting really starts to come into play,” Hudson said. Voters do not have to rank candidates if they do not want to do so. If no candidate wins a majority on the first round of voting, a run-off election can be counted immediately by dropping out candidates at the bottom. If there are several candidates, this process can take many rounds. “A ranked choice or an instant run-off election is just like the run-off elections that have been conducted in the south for years,” Hudson said. “You just don't drag everybody back to the polls and make them cast another ballot to determine the winner in the head-to-head final race.” There's even an example of how the concept works in recent history. On August 20, 2011, the Charlottesville Democratic Party selected their nominees for City Council in a “firehouse primary” and seven candidates were on the ballot. Voting took five-rounds. Write-in candidates could still play a role. In 1993, Sally Thomas won election to the Board of Supervisors on a write-in vote for the Samuel Miller District. In 2019, a write-in candidate for the Rivanna District who failed to qualify for the ballot still received a third of the vote. Legislation carried by Delegate Hudson in 2020 passed the General Assembly and authorizes local government bodies to authorize the use of ranked-choice voting for local office. It's up to the local body to determine how far they want to go. (HB1103)“Whether that ordinance could include primaries, general elections, or both, the state code is flexible on that,” Hudson said. Hudson said the county's costs would be to adjust the voting equipment to handle the counts. She said all vendors are offering the service. “The county would need to update its ballot scanning software if it wanted to offer ranked choice next year,” Hudson said. And that's the conversation supervisors will have tomorrow. Hudson said she would defer to Registrar Lauren Eddy about the costs for the update. She said parties would like to know if this method is a possibility for next year. One option would be to eliminate party primaries in favor of a free-for-all in the general election. The system would also be moot if no one wants to run. All three of the Supervisors elected in 2021 ran unopposed including first-term Supervisor Jim Andrews. He said he was in favor because it may spur more to seek office. “People's decisions to run as candidates can be impacted by ranked choice voting just as much as the electorate's ability to choose among the candidates,” Andrews said. Hudson said more people have run in New York City's 51-seat council since ranked-choice was adopted there and it has made a difference. “They've never had more than I think 18 women and the year after they adopted ranked choice, they have the first majority women city council and the vast majority of those are women of color.”Further discussion is scheduled tomorrow afternoon in the Board of Supervisors' meeting. Reading material to learn more * Charlottesville residents file lawsuit against Charlottesville and City Council over proposed building, Keagan Hughes, NBC29, November 10, 2022* Money pit: How this taxpayer-funded program spent tens of millions of dollars — and is failing a poor Virginia community, Patrick Wilson, Holly Kozelsky, Bill Wyatt, Martinsville Bulletin, November 11, 2022* Virginia tightens landfill rules, Charlie Paullin, Virginia Mercury, November 15, 2022Housekeeping for #459The numbers I use to keep track of this program refer to the installments are perhaps not important, and may not be accurate. I put out two newsletters yesterday, but those were to get information out about the murder of three football players committed late Sunday night. You'll notice I didn't have any shout-outs, and I tried to sound as neutral as possible. Those two were not numbered. I resumed a career in journalism as soon as the pandemic hit. I thought I was ready to move on from deadlines and from devoting my life to being ready to write at a moment's notice. But, something was missing from my life and I didn't feel complete. When I created a podcast to cover the pandemic in March 2020, I acted on autopilot for much of that, feeling guided by something. We are humans who live in a complex civilization in a world that is shifting. My sense is that not many people know how all of the pieces fit together and I believe that the kind of journalism I practice is intended to provide some of what's missing. At least, that's what the imaginary instruction manual for my autopilot seems to say. I'm grateful for those who are supporting me, and for today I'll leave it at that except to thank Ting for matching Substack subscriptions. Details on all of that tomorrow.Thank you to Michael Kilpatrick for recording a small blurb today. And thank you to Wraki and the Fundamental Grang for providing audio. The latter even composed a very small informal public service announcement that remixes one of the soundbites heard in this newsletter. This is for a friend of mine who is trapped in an office today despite having flu-like symptoms. Thanks for listening, and more tomorrow. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit communityengagement.substack.com/subscribe
Despite so much research and evidence there are still so many questions and uncertainties. Victoria and I review the clinical presentation, diagnosis, current and future treatment. Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM Rules LLC
It is likely that you've heard about a child who has had RSV, or Respiratory Syncytial Virus from a friend, a family member, or perhaps you've even had your own personal experience with it. But, you may not realize how common it actually is! Did you know that almost all children get RSV at least once before they are two years old. For healthy children, it is likely to present just like a typical cold or virus, but for some children, they become very ill with RSV. Due to certain infants being more at risk of developing the severe symptoms of RSV, they may receive a series of Synagis injections during the peak RSV season. Infants born prematurely, infants diagnosed with bronchopulmonary dysplasia (BPD), or children with hemodynamically significant congenital heart disease are considered high-risk patients who may be eligible to receive Synagis.October is RSV Awareness Month, which is appropriate because the typical RSV season is from November to April. Since we are approaching the peak RSV season, we are going to review RSV, how it gets transmitted, what the typical symptoms are, and when parents should contact their provider. We will also take a closer look at Synagis, what exactly it is, the current inclusion criteria, how often it should be given, the length of treatment, and signs and symptoms parents should watch for that may be indicative of an allergic reaction. Since RSV is so common and can cause infants and children to require hospitalization, it is important for parents to know preventive measures that will minimize the risk as well as how to identify concerning symptoms. I hope you enjoy this informative episode on RSV and Synagis!Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/NeoTech: https://www.neotechproducts.com/NICU Mama Hats: https://empoweringnicuparents.com/hats/NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/episode39Episode 37 Show Notes: https://empoweringnicuparents.com/episode39Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparentsPinterest Page: https://pin.it/36MJjmH
In this EM Quick Hits podcast: Anand Swaminathan on limitations and practical tips on intraosseus access,Tahara Bhate QI corner on missed ectopic pregnancy, Sarah Reid from EM Cases Summit on oxygen saturation monitoring in bronchiolitis and management of infant gastro-esophageal reflux, Brit Long on the value of rectal exam in diagnosis of cauda equina syndrome, Hans Rosenberg & Ariel Hendin on withdrawal of life-sustaining care in the ED... The post EM Quick Hits 41 – IO Limitations, Missed Ectopic Pregnancy, Bronchiolitis O2 Monitoring, DRE in Cauda Equina Syndrome, Withdrawal of Life Sustaining Care appeared first on Emergency Medicine Cases.
Key points: -Bronchiolitis is seen in kids under the age of 2 and caused by RSV -Treatment is supportive including fluids, oxygen, and suction -Learn about palivizumab and other new preventive therapies against bronchiolitis Supplemental Information: AAP 2014 guidelines: https://pediatrics.aappublications.org/content/134/5/e1474 Day of Illness and Outcomes in Bronchiolitis Hospitalizations: https://publications.aap.org/pediatrics/article/146/5/e20201537/75296/Day-of-Illness-and-Outcomes-in-Bronchiolitis
In this episode, we review the high-yield topic of Bronchiolitis from the Pediatrics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial
Listen in for part 2 of our bronchiolitis episode featuring Dr. Paul Teran and Dr. Adam McClure.
Buckle in and listen to Dr. Adam McClure and Dr. Paul Teran as they discuss all things bronchiolitis. We had so much to discuss that we had to bring them back for part 2 so make sure to tune in for both episodes!
This is how I make sure the abdomen is not surgical, what helps me with the disposition of children with bronchiolitis and how do I decide what ET tube size I need.
Dr. Michael Patrick (Dr. Mike) is an Assistant Professor of Pediatrics at Ohio State University College of Medicine and is the producer and host of Pediacast: a pediatric podcast for parents. Dr. Mike received his MD from Ohio State. He completed residency and fellowship at Nationwide Children's Hospital. Croup and bronchiolitis are two of the most common childhood illnesses. Tune in to learn all about the symptoms, diagnoses, and treatments of croup and bronchiolitis. Dr. Mike has been in podcasting since 2006. Pediacast is a pediatric podcast for parents. There are nearly 500 episodes to listen to. Visit https://www.pediacast.org to hear them all.
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