RESPIRATORY DISTRESS (PED)
DESIGNATION OF CONDITIONPEDIATRIC RESPIRATORY DISTRESS:
• Alert, irritable, anxious
• Stridor
• Audible wheezing/grunting
• Respiratory rate outside normal range for child's age
• Sniffing position
• Nasal flaring
• Head bobbing
• Neck muscle use
• lntercostal retractions
• Central cyanosis that resolves with oxygen administration
PEDIATRIC RESPIRATORY FAILURE:
• Sleepy, intermittently combative or agitated
• Respiratory rate < 10 breaths per minute
• Absent or shallow respirations with poor air movement
• Severe intercostal retractions
• Paradoxical breathing
• Limp muscle tone
• Inability to sit up
• Cyanosis and/or mottled skin
• Bradycardia
ALL LEVELS
EMPHASIS ON PATIENT CARE
Prevent agitation to the patient, airway management, and adequate oxygenation. Patients with stridor from airway infection can decompensate and quickly develop an airway disaster. Calm patient as much as possible and avoid airway manipulation and painful procedures as much as possible unless necessary due to critical condition.
1. Primary Management - Assess ABC’S and manage as indicated.
2. Provide humidified oxygen.
3. Consider underlying cause of respiratory distress and treat appropriately.
a. Anaphylaxis, allergic reaction, asthma, foreign body obstruction, infection.
4. Initiate transport to appropriate facility and consider AEMT/ALS intercept
5. Consider Nebulized Albuterol
6. Secondary Management - History, physical exam, vital signs
7. Continuous EtCO2 SpO2 monitoring
8. Consider CPAP (Basic level).
AEMT
1. Consider IV/IO access
a. Fluid bolus NS/LR at 20 ml /kg for hypotension or dehydration
2. Consider ALBUTEROL 1.25-2.5 mg in 3 ml NS. Or ALBUTEROL/IPRATROPRIUM combination (Duo Neb and others). May repeat as needed.
3. If patient will tolerate may use CPAP up to 10 cm H2O PEEP
4. If respiratory failure develops consider placement of SGA/EGA. LMA preferred.
PARAMEDIC
1. Consider MAGNESIUM SULFATE 50 mg/kg IV if bronchospasm suspected.
2. Consider EPINEPHRINE 1:1,000 (1.0 mg./ml.)
a. Pediatric (less than 25 kg.) 0.15 ml. IM or SQ in anterolateral thigh (preferred) if severe allergic reaction or anaphylaxis suspected.
3. Consider oral DEXAMETHASONE for bronchospasm. Using a TB (1 ml.) syringe draw up 0.6 mg./kg. (0.06 ml./kg.) to a maximum of 10 mg. (1 ml.). Remove needle and administer orally. Check vial’s concentration before drawing it up; usual concentration is 10 mg./ml.
4. See RESPIRATORY DISTRESS/CROUP
5. Do not attempt to intubate if there is adequate air exchange.
6. Intubate the patient only if the patient is 13 years or older and meets other intubation criteria.
DESIGNATION OF CONDITIONPEDIATRIC RESPIRATORY DISTRESS:
• Alert, irritable, anxious
• Stridor
• Audible wheezing/grunting
• Respiratory rate outside normal range for child's age
• Sniffing position
• Nasal flaring
• Head bobbing
• Neck muscle use
• lntercostal retractions
• Central cyanosis that resolves with oxygen administration
PEDIATRIC RESPIRATORY FAILURE:
• Sleepy, intermittently combative or agitated
• Respiratory rate < 10 breaths per minute
• Absent or shallow respirations with poor air movement
• Severe intercostal retractions
• Paradoxical breathing
• Limp muscle tone
• Inability to sit up
• Cyanosis and/or mottled skin
• Bradycardia
ALL LEVELS
EMPHASIS ON PATIENT CARE
Prevent agitation to the patient, airway management, and adequate oxygenation. Patients with stridor from airway infection can decompensate and quickly develop an airway disaster. Calm patient as much as possible and avoid airway manipulation and painful procedures as much as possible unless necessary due to critical condition.
1. Primary Management - Assess ABC’S and manage as indicated.
2. Provide humidified oxygen.
3. Consider underlying cause of respiratory distress and treat appropriately.
a. Anaphylaxis, allergic reaction, asthma, foreign body obstruction, infection.
4. Initiate transport to appropriate facility and consider AEMT/ALS intercept
5. Consider Nebulized Albuterol
6. Secondary Management - History, physical exam, vital signs
7. Continuous EtCO2 SpO2 monitoring
8. Consider CPAP (Basic level).
AEMT
1. Consider IV/IO access
a. Fluid bolus NS/LR at 20 ml /kg for hypotension or dehydration
2. Consider ALBUTEROL 1.25-2.5 mg in 3 ml NS. Or ALBUTEROL/IPRATROPRIUM combination (Duo Neb and others). May repeat as needed.
3. If patient will tolerate may use CPAP up to 10 cm H2O PEEP
4. If respiratory failure develops consider placement of SGA/EGA. LMA preferred.
PARAMEDIC
1. Consider MAGNESIUM SULFATE 50 mg/kg IV if bronchospasm suspected.
2. Consider EPINEPHRINE 1:1,000 (1.0 mg./ml.)
a. Pediatric (less than 25 kg.) 0.15 ml. IM or SQ in anterolateral thigh (preferred) if severe allergic reaction or anaphylaxis suspected.
3. Consider oral DEXAMETHASONE for bronchospasm. Using a TB (1 ml.) syringe draw up 0.6 mg./kg. (0.06 ml./kg.) to a maximum of 10 mg. (1 ml.). Remove needle and administer orally. Check vial’s concentration before drawing it up; usual concentration is 10 mg./ml.
4. See RESPIRATORY DISTRESS/CROUP
5. Do not attempt to intubate if there is adequate air exchange.
6. Intubate the patient only if the patient is 13 years or older and meets other intubation criteria.