Pediatric Respiratory Emergency Management

Overview

• Assessing and managing respiratory emergencies in children is crucial for healthcare providers.
• Focus on understanding the unique characteristics of pediatric airways and recognizing various respiratory emergencies.

Pediatric Airway Characteristics

• Children's airways are smaller and shorter than adults.
• Infant and young children have funnel-shaped larynx, narrowest at cricoid cartilage.
• Large tongue and epiglottis can cause obstructions.
• Larynx is more superior and anterior in children.

Types of Respiratory Problems

1. Upper Airway Obstruction

   • Examples: Croup
   • Signs: Increased respiratory effort, retractions, nasal flaring, inspiratory stridor, hoarseness, barking cough, drooling, snoring.
   • Management: Allow child to maintain a position of comfort.

2. Lower Airway Obstruction

   • Examples: Asthma, Bronchiolitis
   • Signs: Increased respiratory effort, decreased air movement, prolonged exhalation, expiratory wheezing.

3. Lung Tissue Disease

   • Examples: Pneumonia
   • Signs: Increased respiratory effort, grunting, crackles, reduced air movement.

4. Disordered Control of Breathing

   • Examples: Brain injury, Drug overdose
   • Signs: Irregular breathing pattern, decreased respiratory effort, poor muscle tone, altered mental state.

Interventions

• Positioning: Keep children in a comfortable position, often in caregiver's arms.

• Inhaled Medications/Nebulizers:

  • Components: T-piece, oxygen tubing, nebulizer bottle, mouthpiece/mask, oxygen source.
  • Purpose: Open airways by decreasing edema or improving bronchoconstriction.

• Oxygen Administration:

  • Low flow systems for stable conditions (e.g., nasal cannula, simple masks).
  • High flow systems for higher needs (e.g., non-rebreather face masks, high flow nasal cannula).

• Positive Pressure Ventilation:

  • Bag-Mask Ventilation: Delivers high oxygen concentration, requires at least 10 L/min flow rate.
  • Suctioning: Use suction devices to clear airway, limit suction to 10 seconds.
  • Oropharyngeal Airway: For unconscious patients, prevents tongue obstruction.

Advanced Airway Management

• Endotracheal Intubation:

  • Indicated when basic interventions fail, requires careful monitoring and equipment.
  • Confirm tube placement with CO2 detection.

• Laryngeal Mask Airway:

  • Used when direct visualization is not possible; as a rescue device.

Complications & Monitoring

• Mnemonics: DOPE:

  • Displacement: Incorrect tube position.
  • Obstruction: Secretions or foreign body.
  • Pneumothorax: Reduced chest expansion and breath sounds.
  • Equipment failure: Check connections and functionality.

• Monitoring: Check heart rate, oxygen saturation, and clinical appearance during interventions.

Conclusion

• Respiratory issues are the most common pediatric emergencies, making understanding pediatric airways and management techniques essential for healthcare providers.