Clinical Pathways
Clinical Pathways
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Decision

Pleuritic pain, SOB, rales, wheeze, cough, sickle cell disease, cystic fibrosis?

icon
Yes → Order chest x-ray, consider albuterol metered-dose inhaler (Class II)

Background

Treatment of Pulmonary Conditions

For pediatric chest pain in which pulmonary causes are suspected, treatment will be guided by the underlying pathophysiology. Patients who are found to have a pulmonary embolism will require cardiac monitoring, oxygen supplementation, and anticoagulation with heparin or low-molecular-weight heparin, provided contraindications do not exist. Hemodynamically unstable patients with pulmonary embolism may be candidates for thrombolysis. IV fluids and intubation should be used with great caution in patients with significant pulmonary embolism.

If bronchospasm is suspected, a trial of inhaled beta agonist in the ED may provide relief and improve diagnostic certainty if a significant improvement is noted;131^{131} an albuterol metered-dose inhaler with spacer, 2 to 4 puffs every 4 hours is recommended.

Many pediatric patients with uncomplicated community-acquired pneumonia who present with chest pain can be difficult to manage as an outpatient. If the patient’s pain can be relieved in the ED and the patient is not vomiting, hypoxic, or dehydrated, initiating oral amoxicillin 90 mg/kg/day divided every 12 hours for 7 days (up to a maximum of 4000 mg/day) and oral ibuprofen 10 mg/kg/dose (up to a maximum of 600 mg/dose) every 6 hours, is recommended for outpatient management.128^{128}

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References
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No pleuritic pain, SOB, rales, wheeze, cough, sickle cell disease, cystic fibrosis
No pleuritic pain, SOB, rales, wheeze, cough, sickle cell disease, cystic fibrosis
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