PP-9001 Pediatric Airway Obstruction by Foreign Body and Respiratory Arrest.pdf

COUNTY OF SACRAMENTO Document # 9001.17 EMERGENCY MEDICAL SERVICES AGENCY PROGRAM DOCUMENT: Initial Date: 01/30/95...

COUNTY OF SACRAMENTO Document # 9001.17 EMERGENCY MEDICAL SERVICES AGENCY PROGRAM DOCUMENT: Initial Date: 01/30/95 Pediatric Last Approval Date: 03/11/21 Airway Obstruction by Foreign Body and Respiratory Arrest Effective Date: 07/01/21 Next Review Date: 03/01/24 Signature on File Signature on File EMS Medical Director EMS Administrator Purpose: A. To establish the treatment standard for pediatric patients assessed with a partial or complete airway obstruction by a foreign body. B. To establish a treatment standard for pediatric patients assessed to be in respiratory arrest. Authority: A. California Health and Safety Code, Division 2.5 B. California Code of Regulations, Title 22, Division 9 Protocol: Blind finger sweeps shall NOT be used. Keep patient calm and in position of comfort. A. Signs and symptoms of foreign body airway obstruction (FBAO): 1. Sudden onset of respiratory distress with coughing 2. Gagging 3. Stridor 4. Wheezing B. Signs of severe obstruction: 1. Poor air exchange 2. Increased breathing difficulty 3. Silent cough 4. Cyanosis 5. Inability to speak or breath 9001.17-Page 1 of 2  BLS Access ABC’s Reassure patient/encourage coughing O2 as necessary to maintain SpO2 ≥ SIGNS OF SEVERE 94% NO OBSTRUCTION? Suction as needed to control secretions Transport in position of comfort YES If patient < 1 year old: If BRUE refer to 5 back blows followed by 5 chest thrust BRUE Policy If patient > 1 year old: PD# 9019 Abdominal thrust in rapid sequence, If ineffective consider chest thrust Reassess airway, if still not clear repeat above steps until clear or unconscious If patient becomes unconscious: Begin chest compressions Prior to ventilating, attempt to visualize and remove any foreign bodies. Begin ventilations Transport patient along with any foreign body removed from airway ALS Visualize airway-use appropriate size laryngoscope Maintain airway and O2 as blade and pediatric Magill forceps. necessary to maintain SpO2 ≥ 94% VENTILATING Use least invasive airway management method YES NO Monitor and reassess ADEQUATELY? possible to ensure adequate ventilation and Transport oxygenation, as determined by O2 saturation and capnography monitoring (if available). Begin with BVM assisted ventilation. Utilize intubation per Pediatric Airway Management Policy 8837 if BVM ventilation does not ensure BVM or adequate ventilation and oxygenation. All Intubation patients with advanced airways shall have end- successful? tidal CO2 detector or other approved confirming device. In addition, continuous waveform capnography will be utilized throughout transport and until transfer of care has occurred. Perform Blood Glucose determination Treat per policy 9007- Pediatric Diabetic Emergencies Hypoglycemia (blood sugar < 60 mg/dL) Initiate VASCULAR ACCESS. Titrate to a minimal Systolic Blood Pressure (SBP) for patient's age. Cross Reference: PD# 9007- Pediatric Diabetic Emergencies PD #9019 - Brief Resolved Unexplained Event (BRUE) PD# 8837 - Pediatric Airway Management 9001.17-Page 2 of 2