SAN DIEGO—When it comes to pertussis, croup, or upper respiratory infections, sometimes emergency physicians need to listen with their eyes.

That was one of the clinical pearls at the ACEP18 session, “Cough, Stridor, and Wheeze in the Pediatric Patient: Gone in 30 Minutes,” presented by Ian Kane, MD, a pediatric emergency physician at the Medical University of South Carolina in Charleston. Dr. Kane said treating children with these conditions isn’t just about listening for the crackles emergency physicians worked hard to learn in medical school. It’s more about being a detective.

“Take advantage of what these kids are showing us when they come in,” he said. “It’s not just what you hear with the stethoscope. It’s the whole picture. It’s the history. And it’s what they sound like from across the room. It’s what they look like from across the room. That really can guide your therapy more than what you hear in the lungs sometimes. Those can be findings that are transient and less reliable, whereas the big picture—the ‘sick or not sick’—is what you can determine from the doorstep.”

Dr. Kane highlighted the need to use epinephrine in cases of anaphylaxis. He said too many physicians are reticent to use the treatment, despite it being the only one shown to have a positive impact on mortality. He hopes that by presenting the information in an academic setting, physicians will be prepared to deploy that knowledge when children present with symptoms during a hectic 3 a.m. visit, complete with panicked parents.

“It’s so important to keep drumming that message home…because we keep sliding back on this,” he said. “It would seem to be straightforward that for anaphylaxis you need epinephrine. And yet study after study shows that even pediatric emergency rooms don’t do this well. We have to keep reiterating that.”

In fact, Dr. Kane adds, emergency physicians need to impress that not just on themselves, but on the parents of their pediatric patients. For children, those caregivers are going to be the first line of defense and they need to be educated as well.

“It gets treated at home,” Dr. Kane said. “They just need to know that before they reach for an antihistamine, before they reach for something else, they just need to give epinephrine. If they’re on the fence about what to do, they need to give epinephrine. We just need to keep emphasizing that because that’s the only treatment that really helps.”