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Upon completion of this lecture, you will be better able to:

• Define the most common types of respiratory emergencies in school-aged children

• List the steps in assessing a child who is experiencing respiratory distress

• Describe the proper interventions for selected respiratory emergencies

RESPIRATORY OBJECTIVES

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RESPIRATORY EMERGENCIES

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CAUSES OF RESPIRATORY EMERGENCIES

• Infection

• Trauma

• Congenital conditions

• Allergic conditions

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INCREASE IN CHRONIC RESPIRATORY CONDITIONS

• Asthma

• Pertussis

• TB

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FAILURE TO RECOGNIZE AND

TREAT RESPIRATORY DISTRESS CAN

LEAD TO CARDIAC FAILURE

AND DEATH!!!

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ANATOMIC AND PHYSIOLOGIC DIFFERENCES

• CNS Control of Breathing

• Airway

• Chest wall differences

• Respiratory muscles

• Lung tissue

• Gas Transport

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PREDISPOSING CONDITIONS

• Allergies• Asthma• Cardiac Anomalies• Cystic Fibrosis• Smoking• Immunodeficiencies

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EQUIPMENT NEEDS

• Basic First-Aid

• Body fluid isolation supplies

• Stethoscope

• Peak flow meters

• Epinephrine 1:1000

• Protocols with phone numbers

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ASSESSMENT

HISTORY• CIAMPEDS

PHYSICAL ASSESSMENT• ABC's• Signs and symptoms of

respiratory distress

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SIGNS AND SYMPTOMS OF RESPIRATORY DISTRESS

• RESPIRATORY RATE– Increased early, decreased late – NOTE: A SLOW RESPIRATORY RATE IS AN

OMINOUS SIGN IN CHILDREN

• RESPIRATORY OBSERVATIONS– Nasal flaring – Retraction

• USE OF ACCESSORY MUSCLES• COUGHING

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SIGNS & SYMPTOMS

• Abnormal Breath Sounds– Wheezing - hallmark sign of lower airway obstruction

– Inspiratory Stridor - hallmark sign of upper airway obstruction

– Decreased, absent, unequal breath sounds

– Expiratory Grunting - LATE sign

• Color– Cyanosis is a late sign

• Level of consciousness– Somnolence/lethargy is a late sign

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Signs of Respiratory Distress

NOTE:

Cyanosis is alate sign ofrespiratory

distress

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PLAN AND INTERVENTIONS

• Maintain position of comfort• Deliver oxygen if available• Avoid procedures that might agitate the

student• Reassure the student• Administer standing order medications• Transport

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TRIAGE AND TRANSPORT EMERGENT

Signs and symptoms of severe distress

and impending failure:– Cyanosis, lethargy, or agitation

– Absent or severely decreased breath sounds

– Apnea, bradycardia, severe retractions, or grunting

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TRIAGE AND TRANSPORT URGENT

Student with chronic condition and/or

is in mild distress

– Decreased air movement (minimal)

– Mild retractions

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TRIAGE AND TRANSPORT NON-URGENT

• No signs or symptoms of distress

• Breath sounds normal

• Color normal

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UPPER AIRWAY EMERGENCIES

• CROUP

• EPIGLOTTITIS

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SIGNS AND SYMPTOMS OF CROUP AND EPIGLOTTITIS• CROUP

– Gradual onset– Barky cough– Low grade fever– Hoarse voice– Inspiratory stridor– Other

signs/symptoms depend on distress

• EPIGLOTTITIS– Sudden onset– Muffled cough less

prominent– High fever– Inspiratory stridor– Difficulty swallowing– Tripod positioning– Drooling (not always)

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CROUP• Inflammation of area around

vocal cords and trachea

• Commonly caused by parainfluenza virus

• Occurs mostly in children 3 months to 3 years of age

• More prevalent in cooler months

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CROUPIMMEDIATE INTERVENTIONS

Mild distress• Notify parent/guardian and/or physician• Observe for worsening of distress

Moderate to severe distress• Cold steam from vaporizer, cold air, or steam

from hot water faucets• Call EMS, notify parent/guardian and physician

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EPIGLOTTITIS

• Life-threatening bacterial infection of the epiglottis

• Most often caused by Haemophilus influenzae type B

• Most commonly seen in children age 2-6 years, however with immunization compliance, older children and young adults are more commonly affected

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SOFT TISSUE SWELLING

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EPIGLOTTITISImmediate Interventions

• TREAT AS EMERGENT!!!!• Call EMS and arrange for immediate

transport• DO NOT MANIPULATE AIRWAY!• Do not upset the student• Apply oxygen, if available and

if the student will tolerate

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FOREIGN BODIES

• Food

• Small toys

• Other objects

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LOWER AIRWAY EMERGENCIES

• Asthma• Bronchiolitis• Pneumonia• Pneumothorax

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ASTHMA

• Recurrent and reversible airway obstruction

• Status asthmaticus - Severe airway obstruction that is life-threatening

• Caused by allergens and other factors

• Risk factors include prior intubation, multiple hospital stays, and use of steroids

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• Assess Airway

• Auscultate breath sounds

• Evaluate work of breathing

INITIAL ASSESSMENT OF ASTHMA

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ASTHMA ASSESSMENT

• Respiratory distress

• Severe anxiety

• Decreasing level of consciousness

• Tachypnea, tachycardia or bradypnea, bradycardia with impending respiratory failure

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ASTHMA

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INTERVENTIONS FOR ASTHMA

• Reassure student

• Measure Peak Flow– Green (80% - 100% of personal best)– Yellow (50% - 80% of personal best)– Red (< 50% of personal best)

• Administer medications per protocol

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EXPECTED OUTCOMES WITH ASTHMA

• Decreased respiratory distress

• Decreased work of breathing

• Improved air exchange

• Decreased anxiety

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EVALUATION/FOLLOW UP WITH ASTHMA

• Record asthma attacks on student’s health record

• Follow up with primary health care provider

• Revise IEMP as needed

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Asthma Tips

• Teach students to avoid asthma triggers

• Keep medications available

• Obtain thorough assessment of students with respiratory distress and complete asthma histories (history should include prior hospitalizations and intubations)

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BRONCHIOLITIS

• Viral disease, affects children under the age of one year

• Respiratory Synctial Virus (RSV) most common cause

• History of runny nose and cough, poor fluid intake

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PNEUMONIA

Pneumonia is an infection of the lower respiratory tract

• CAUSES– Infants and preschool children: viruses likely– School-aged children: Mycoplasma more

common than viruses– NOTE: TB pneumonia is reappearing

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PNEUMONIA

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PNEUMONIA: SIGNS AND SYMPTOMS

• OLDER CHILDREN– Cough

– Fever

– Pleuritic pain

– Dyspnea

– Tachypnea

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PNEUMONIA SIGNS AND SYMPTOMS

YOUNGER CHILDREN• Fever• Irritability• Poor feeding• Vomiting and diarrhea• Apnea

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IMMEDIATE INTERVENTIONS

• Assess degree of distress

• Contact EMS for severe distress

• Contact parent/guardian for mild distress; child may need MD evaluation

• Continually evaluate for worsening of symptoms

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PNEUMOTHORAX

CAUSES

– Trauma to chest

– Asthma

– Pneumonia

– Cystic fibrosis

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TYPES

• Simple pneumothorax

– Blunt or penetrating trauma

– Spontaneous pneumothorax

• Hemothorax

• Open pneumothorax

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SIGNS AND SYMPTOMS

• Dyspnea

• Chest pain

• Decreasing breath sounds on affected side

• Agitation

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SPECIAL NEEDS CHILDREN• Congenital heart disease• Cystic fibrosis• Conditions affecting the

immune system• Children with artificial airways• Children requiring oxygen• Children with physical

deformities• Children with seizures

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PREVENTION

• Be aware of children with allergies

• Provide medical-alert bracelets

• Ensure teachers and other support staff receive CPR and First Aid training

• Have proper equipment in schools

• Be aware of treatment plans

• Encourage immunizations

• Teach parents/guardians about relationship between smoking and respiratory distress

• Make all school areas non-smoking

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SUMMARY

Respiratory illnesses are common in preschoolers and school-aged children and is partly due to the

unique anatomic and physiologic factors that increase their susceptibility to respiratory

problems. Left untreated, respiratory distress can lead to respiratory failure and cardiopulmonary

arrest.

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ANY QUESTIONS??