Reply to two pediatric case- studies

Sep 13, 2023

1. J45.9: Asthma, unspecified. Two classic symptoms of asthma are cough and wheezing which can be triggered by numerous factors including an upper respiratory tract infection or exposure to allergens. The classic triad of asthma, eczema, and allergies underscores their interrelation also known as the “Atopic March or Atopic Triad” (Lizzo & Cortes, 2023). The exact cause is unknown, but it is believed to be influenced by both genetic and environmental factors (Lizzo & Cortes, 2023). Prior to a formal asthma diagnosis, children may be preliminarily labeled with reactive airway disease or wheezing associated with respiratory infections (Lizzo & Cortes, 2023). 

2. J06.9: Acute upper respiratory infection, unspecified. Cough and wheezing could be due to a viral or bacterial respiratory infection. Allergies (part of the classic triad) do not directly cause upper respiratory tract infections, but they can contribute to an increased risk of development due to inflammation and congestion of the respiratory system (Lizzo & Cortes, 2023). 

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3. H65.01: Acute serous otitis media, right ear. Typically, AOM follows a viral upper respiratory tract infection in children. It is the second most common pediatric diagnosis in the emergency department following upper respiratory infections (Danishyar & Ashurt, 2023).

4. L20.9: Atopic dermatitis, unspecified. The presence of dry, scaly patches in the flexural regions such as the elbows and popliteal fossa raises suspicion for atopic dermatitis, a prevalent form of eczema seen in the pediatric population (Kolb & Ferrer-Bruker, 2022). This condition is frequently linked to other IgE-mediated disorders, including allergic rhinitis, asthma, and food allergies (Kolb & Ferrer-Bruker, 2022).

Treatment & Management

1. Asthma: pediatric patients who present with an acute exacerbation should be assessed immediately to determine if they need a higher level of care. The following recommendations are provided by Lizzo and Cortes (2023):

· Diagnostic:

· Chest X-ray: may reveal hyperinflated lungs and interstitial prominence. 

· Allergy Testing

· Spirometry

· Non-Pharmacologic:

· Trigger Avoidance

· Pharmacologic: 

· Metered-dose Inhalers

· Nebulizers (Albuterol, Ipratropium)

· Corticosteroids 

2. Upper Respiratory Tract Infection: the etiology is presumed to be primarily viral, however; to confirm or rule out a bacterial origin, a swab and culture should be obtained for definitive identification. 

· Viral: supportive care including rest, fluids, and fever management.

· Bacterial: targeted antibiotic therapy.

3. Acute Serious Otitis Media: the primary treatment objective is effective pain management and administration of antibiotics. “Watchful waiting” has not gained wide acceptance in the United States (Danishyar & Ashurst, 2023).

· Pain Control: NSAIDs or acetaminophen.

· Antibiotics: high-dose amoxicillin or a second-generation cephalosporin are the first-line agents (Danishyar & Ashurst, 2023).

· TM Perforation: ototopical antibiotics such as ofloxacin deliver higher concentrations without any systemic side effects (Danishyar & Ashurst, 2023).

4. Atopic Dermatitis: Kolb and Ferrer-Bruker (2022) identify four major components of treatment which include:

· Trigger Avoidance

· Daily Skin Care: keep the skin moisturized with hypoallergenic emollients twice daily, applying within 3 minutes of exiting a lukewarm bath or shower to prevent skin drying. 

· Anti-inflammatory Therapy: topical corticosteroids, topical calcineurin inhibitors, systemic corticosteroids, antihistamines, and immunosuppressants. These agents reduce inflammation, control symptoms, and reduce the potential for flare-ups. Use is dependent on severity.

· Complementary Modalities: 

· Probiotics may benefit some patients as it is believed that the bacterial products may enhance the immune system and prevent the development of allergic IgE antibody response.

· Bleach baths may relieve symptoms by lowering the risk of superinfection with bacteria.

· Phototherapy with UVA/UVB light


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