Half of our attendings believe that there is an Asthma plan and there is a Bronchiolitis plan – and by mixing the two you might as well be burning incense and chanting ritual Latin over the soon-to-be dead-of-malpractice baby, you non-EBM heathen, you.
… Honestly, their clear-cut attitude greatly appeals to my Evidence-Based soul.
But the other half of our attendings will not take kindly to your clear-cut plan. They’ll just ask you where you got those 10 slabs of stone engraved by God with the Official Universal Rules On Exactly Where The Airway Inflammation Resides In This Particular “Bronchiolitic”.
Who are you to say that a trial of albuterol is pointless just because it’s bronchiolitis? they ask. Are you 100% sure it won’t help?
… and they probably have a point too. Right? I mean.. it makes sense that all inflammation is a continuum and could happen in multiple locations, so why not trial albuterol?
But I’m sick and tired of admitting kids for respiratory distress just to get mocked for my inability to Adhere To Established AAP Guidelines (if the attending falls in Camp 1) or Understand That Airway Inflammation Is A Continuum (if they turn out to adhere to Camp 2).
I didn’t get into medicine just to stake my supposedly scientific plan solely on the attending-of-the-hour’s personal ideology when not even Nelson can explain this shit to me.
The Respiratory Therapists are no help, either. My favorite RT once told me:
“It’s not so much a matter of where the inflammation is – what you’ve got to remember is that kids don’t even have bronchiolar smooth muscle until 2 years of age, so even if they ARE asthmatic, albuterol won’t help. That’s why some people say there’s no point to the albuterol trial.”
Which sounded like the solution to all my problems until I actually looked it up. (Spoiler alert: not true).
So I bit the bullet and took a pediatric pulmonary elective. Because the Pulmonologists should know, right? THEY SHOULD HAVE THE ANSWERS.
And my very first case of “This is definitely, 100% verifiable on formal PFT and albuterol testing, clear-cut URI-triggered asthma”… what does the Pediatric Pulmonologist diagnos it as?
MOTHER-EFFING FULL-ON ADULT BRONCHITIS because fuck you, that’s why.
I hereby rescind all my respect for the respiratory tract. May god have mercy on its stupid, alveoli-filled soul.
This shouldn’t be so hard. Air goes in, air goes out – unless it’s blocked by inflammation, which should be able to be attacked by obvious anti-inflammatory measures, unless it can’t be because of, I don’t know, reasons no one will ever tell me.
Screw you, lungs.
Agreed completely. Unless the kid is tachycardic at 150+ then just give the albuterol and see what happens.
Because the simple reality is that its hard to know at any time, let along in real time, whether this is asthma or bronchiolitis or RAD.