“ Pediatric respiratory emergencies” (Nelson, O.P. Ghai,) Presented By: Dr. Wasim Akram Moderator Dr. R. S. Sethi (MD, DCH) Professor & Ex. HOD Dr. Om Shankar Chaurasiya (MD) Assistant Professor & Head Dr. G. S. Chaudhary (MD) Lecturer Dr. Aradhana Kankane (MD) Lecturer DEPARTMENT OF PAEDIATRICS M. L. B. Medical College, Jhansi Dr. Anuj Shamsher Sethi (MD) Lecturer Dr. Sapna Gupta (MD) Lecturer & All Resident
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– 4)See saw respiration it is seen in neuromuscular
weakness, but can also occur in late stage of severe
respiratory pathology
– 5)pulse oximetry measure % saturation of hb with
oxygen
–
3)Circulation
– PR
– Pulse volume: feeble pulse is the first sign of
compromised perfusion
– CRT
– BP
4)Disability
– Reduced O2 supply to brain affects consciousness muscle
tone and pupillary response
– Early manifestations are anxious look and irritability and
agitation followed by lethargy
5)Exposure
– If indicated it is done to look for evidence of trauma,
petechae and purpura and warming
Categorization of severity of the
clinical condition
– Life threatening conditions
– If at any point during the assessment, a life threatening
condition is identified, appropriate interventions are
instituted, before proceeding with the rest of the
assessment.
Signs of life-threatening illness in a child
with respiratory distress
Airway BreathingCirculationDisabilityExposure
Complete or severe airway obstructionApnea/bradypnea, markedly Increased work of breathingAbsence of detectable pulse, poor perfusion, hypotension, bradycardiaUnresponsivenessSignificant hypothermia or bleeding, petechae/purpura consistent with septic shock
Immediate care
– The goal is to relieve hypoxemia and support respiratory functions until specifictherapy becomes effective.
– This is done by (a) Ensuring an open airway and breathing, (b) Delivering oxygenwithout causing agitation, and (c) Ensuring adequacy of circulation, normaltemperature and hydration.
– Airway patency can be achieved with
a) Proper positioning (extend the neck, pull the mandible forward, to lift thetongue),
b) Cleaning the oropharynx of any secretions (manually if necessary), and
c) Insertion of an oropharyngeal airway.
Ensure breathing if spontaneus normal breathing isabsent/inadequate by:
(a) Assisted ventilation by bag and mask ventilation,
(b) Endotracheal intubation as soon as adequate expertiseand equipment are available,
(c) Providing oxygen. Never delay resuscitation tor lack ofequipment or trained personnel.
Ventilation
– Nasal prongs are the recommended way of providing oxygen to most of the
children
– Infant 5 to 1l/min
– Child 1 to 2 litre
However there is no significant difference in oxygen administration by nasal prongs
or nasopharyngeal catheters
For older children oxygen is best given by face mask
Common oxygen delivery devices and
delivered oxygen concentration (FiO2) at given
flow rates
FiO2 Device (Flow rate/min)
25 – 50 % Nasal cannula (1 – 6 L) Nasal prons
35 – 65 % Simple Face Mask (6 – 12 L)
24 – 60 % Graded ventury mask (graded 4 – 12 L)
60 – 80 % Oxyhood (10 – 15 L)
> 90 % Non rebreathing masks ( 10 – 12 L)
Ensure circulation
– If the patient is in shock, or has signs of severe sepsis, initiate
septic shock protocol. Establish intravenous access and initiate
infusion of a saline bolus (20mg/kg).
– If venous access is not feasible, consider intrasseous infusion in
young children.
– The first dose of an appropriate antibiotic for severe infections,
including severe respiratory infection, must be administered
without delay.
Subsequent management
– If pneumothorax is suspected/detected, proceed with
needle thoracotomy in the second intercostal space
under water seal (using a syringe with saline), followed