Week 12.2 Pediatric Respiratory Emergencies PDF

HEM - 2123 HARMIYA HAKKIM  PEDIATRIC RESPIRATORY EMERGENCIES Sunday, November 17, 2024  WEEK-12.2 PEDIATRIC RESPIRATORY EMERGENCIES SECTION OVERVIEW  Respiratory Distress  Respiratory Failure  Upper Airway Pro...

HEM - 2123 HARMIYA HAKKIM  PEDIATRIC RESPIRATORY EMERGENCIES Sunday, November 17, 2024  WEEK-12.2 PEDIATRIC RESPIRATORY EMERGENCIES SECTION OVERVIEW  Respiratory Distress  Respiratory Failure  Upper Airway Problems  Lower Airway Problems  Airway and Breathing Management  Basic airway management  Advanced airway management Sunday, November 17, 2024  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 4 RESPIRATORY EMERGENCIES  Frequently encountered  Respiratory failure and arrest precede (before) majority of cardiac arrests.  Early identification and intervention are critical  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 5 RESPIRATORY DISTRESS & FAILURE  RESPIRATORY DISTRESS: Increased work of breathing results in adequate gas exchange.  RESPIRATORY FAILURE: Patient can no longer compensate; hypoxia and/or carbon dioxide retention occur.  RESPIRATORY ARREST: Patient stops breathing.  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 6 RESPIRATORY DISTRESS & FAILURE  Use PAT to determine severity before touching the patient.  Assess work of breathing by noting:  Patient’s position of comfort  Presence or absence of retractions  Grunting or flaring  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 7 RESPIRATORY DISTRESS & FAILURE  Determine whether the patient is in respiratory distress, failure, or arrest.  Respiratory distress requires generic treatment.  With fatigue, distress may progress to failure.  Reassess frequently.  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES UPPER AIRWAY PROBLEMS  FBAO (and choking)  Croup  Epiglottitis  Anaphylaxis  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 9 FOREIGN BODY ASPIRATION /OBSTRUCTION Infants and toddlers have a high risk of foreign body aspiration. Mild obstruction:  Awake  Stridor  Increased work of breathing  Good color Severe obstruction  Cyanotic  Unconscious  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 10 FOREIGN BODY ASPIRATION /OBSTRUCTION Removing a foreign body: Responsive infants  Deliver five back slaps and five chest thrusts.  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 11 FOREIGN BODY ASPIRATION /OBSTRUCTION Removing a foreign body: Unresponsive infants  Look inside the mouth; remove object if visible.  If not, begin CPR (even if pulse is present).  30 compressions  LOOK inside the mouth FIRST  Attempt to ventilate  Assess for a pulse  Repeat  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES FOREIGN BODY ASPIRATION /OBSTRUCTION 12 Removing a foreign body in children:  Use the Heimlich maneuver.  If the child becomes unresponsive:  Look inside the mouth; remove object if visible.  If not, begin CPR (even if pulse is present).  30 compressions  LOOK inside the mouth FIRST  Attempt to ventilate  Assess for a pulse  Repeat  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES FOREIGN BODY ASPIRATION /OBSTRUCTION 13 Advanced Paramedics can do the following using McGill's Forceps  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 14 CROUP  Viral infection of the upper airway  PAT typically reveals an alert infant or toddler with the following:  Audible stridor  Barky cough  Some increased work of breathing  Normal skin color  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 15 CROUP Initial management:  Position of comfort  Avoid agitating the child  Nebulize with normal 0.9% saline (IV fluid)  If SEVERE call an Advanced Paramedic  To nebulize with Epinephrine  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 16 EPIGLOTTITIS  Inflammation of the supraglottic structures  Classic presentation:  Sick, anxious  Drooling  Increased work of breathing  Pallor or cyanosis  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 17 EPIGLOTTITIS  Symptoms progress rapidly.  Ask about immunizations, and get the child to an appropriate hospital.  Be prepared with a bag-mask device  Call advanced paramedic  Nebulized Epinephrine  Humidified oxygen  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 18 ANAPHYLAXIS  Potentially life-threatening allergic reaction  Triggered by exposure to an antigen  Typically affects children older than 2 years.  Onset of symptoms occurs immediately.  Hives  Respiratory distress  Circulatory compromise  Gastrointestinal symptoms  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 19 ANAPHYLAXIS Severe anaphylaxis  Child may be unresponsive.  Primary assessment may reveal:  Hives  Swelling of the lips and oral mucosa  Stridor and/or wheezing  Diminished pulses WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 20 ANAPHYLAXIS CPG  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 21 ANAPHYLAXIS Treatment of anaphylaxis should include:  Epinephrine  Supplemental Oxygen  Fluid Resuscitation for shock  Antihistamine medications  Bronchodilator medications  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 22 ANAPHYLAXIS MEDICATIONS  Epinephrine (1:1,000) - Severe allergy or anaphylaxis  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 23 ANAPHYLAXIS MEDICATIONS Chlorpheniramine  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES LOWER AIRWAY PROBLEMS  Bronchiolitis  Asthma  Pneumonia  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 25 BRONCHIOLITIS  Inflammation or swelling of small airways in lower respiratory tract due to viral infection  Highly contagious  Characteristic findings include:  Mild to moderate retractions  Tachypnea  Diffuse wheezing  Mild hypoxia  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 26 BRONCHIOLITIS  Management is entirely supportive.  Position of comfort  Supplemental oxygen  Humidified oxygen  Inhaled salbutamol may be given for moderate to severe respiratory distress  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 27 ASTHMA  Chronic disease  Generally diagnosed only after 2 years of age  Disease of the small airways  Main components:  Bronchospasm  Mucus production  Airway inflammation  Results in hypoxia  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 28 ASTHMA TRIGGERS CLINICAL SIGNS  Upper respiratory infections  Frequent cough  Allergies  Wheezing  Exposure to cold  General signs of respiratory distress  Changes in the weather  Secondhand smoke  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 29 ASTHMA WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 30 ASTHMA CPG  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 31 ASTHMA Initial management:  Position of comfort  Supplemental oxygen  Bronchodilators  Salbutamol  Ipratropium Bromide  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 32 PNEUMONIA  Disease infecting lower airway and lung  Normally a bacterial infection  Child will require antibiotics Signs include:  Unusually rapid breathing  Grunting or wheezing/crackles  Hypothermia or fever (MORE LIKELY)  Primary treatment is supportive.  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 33 AIRWAY MANAGEMENT  Look for obstruction.  Position airway.  Sniffing position  Airway adjunct may be helpful.  OPA/NPA  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 34 AIRWAY MANAGEMENT SNIFFING POSITION  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 35 AIRWAY MANAGEMENT OPA & NPA  Keeps the tongue from blocking the airway - OPA  Used for conscious patients and patients with altered levels of consciousness  Rarely used for children younger than 1 year  Do not use with facial trauma or moderate to severe head trauma.  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 36 AIRWAY MANAGEMENT OXYGENATION  All children with respiratory emergencies should receive supplemental oxygen.  Common methods for pediatric patients  Blow-by technique  Non-rebreathing mask  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 37 AIRWAY MANAGEMENT OXYGENATION Blow-by technique Best used when:  Small amount of oxygen is needed.  Patient cannot tolerate the mask.  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 38 AIRWAY MANAGEMENT OXYGENATION Nonrebreathing mask preferred for:  Respiratory distress or failure  Older children  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 39 AIRWAY MANAGEMENT BAG-MASK VENTILATION  Use if airway positioning or adjunct does not improve respiratory effort.  May need to try a variety of mask sizes.  Deliver breaths at a rate of 12 to 20 breaths/min for infants and children.  Depends on their age  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 40 AIRWAY MANAGEMENT BAG-MASK VENTILATION  Ensure that equipment is the right size.  Maintain a good seal with the face.  Ventilate at the appropriate rate and volume.  WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 41 AIRWAY MANAGEMENT BAG-MASK VENTILATION  Errors in technique can result in gastric distention or a pneumothorax.  DO NOT HYPERVENTILATE  Squeeze the bag only till you see chest rise.  Two-person bag-mask ventilation is usually more effective. WEEK 12.2- PEDIATRIC RESPIRATORY EMERGENCIES 42 ADVANCED AIRWAY MANAGEMENT CPG  WEEK-2.1 ,GYNECOLOGICAL EMERGENCIES 43 [email protected] Thank You