RESPIRATORY OBJECTIVES 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 Illinois EMSC

RESPIRATORY EMERGENCIES Illinois EMSC

CAUSES OF RESPIRATORY EMERGENCIES Infection Trauma Congenital conditions Allergic conditions Illinois EMSC

INCREASE IN CHRONIC RESPIRATORY CONDITIONS Asthma Pertussis TB Illinois EMSC

FAILURE TO RECOGNIZE AND TREAT RESPIRATORY DISTRESS CAN LEAD TO CARDIAC FAILURE AND DEATH!!! Illinois EMSC

ANATOMIC AND PHYSIOLOGIC DIFFERENCES CNS Control of Breathing Airway Chest wall differences Respiratory muscles Lung tissue Gas Transport Illinois EMSC

Illinois EMSC

Illinois EMSC

PREDISPOSING CONDITIONS Allergies Asthma Cardiac Anomalies Cystic Fibrosis Smoking Immunodeficiencies Illinois EMSC

EQUIPMENT NEEDS Basic First-Aid Body fluid isolation supplies Stethoscope Peak flow meters Epinephrine 1:1000 Protocols with phone numbers Illinois EMSC

ASSESSMENT HISTORY PHYSICAL ASSESSMENT A B C's CIAMPEDS ABC's Signs and symptoms of respiratory distress A B C's Illinois EMSC

Illinois EMSC

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 Illinois EMSC

Illinois EMSC

SIGNS & SYMPTOMS Abnormal Breath Sounds Color Level of consciousness 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 Illinois EMSC

Signs of Respiratory Distress NOTE: Cyanosis is a late sign of respiratory distress Illinois EMSC

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 Illinois EMSC

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 Illinois EMSC

TRIAGE AND TRANSPORT URGENT Student with chronic condition and/or is in mild distress Decreased air movement (minimal) Mild retractions Illinois EMSC

TRIAGE AND TRANSPORT NON-URGENT No signs or symptoms of distress Breath sounds normal Color normal Illinois EMSC

UPPER AIRWAY EMERGENCIES CROUP EPIGLOTTITIS Illinois EMSC

SIGNS AND SYMPTOMS OF CROUP AND EPIGLOTTITIS Sudden onset Muffled cough less prominent High fever Inspiratory stridor Difficulty swallowing Tripod positioning Drooling (not always) CROUP Gradual onset Barky cough Low grade fever Hoarse voice Inspiratory stridor Other signs/symptoms depend on distress Illinois EMSC

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 Illinois EMSC

CROUP IMMEDIATE 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 Illinois EMSC

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 Illinois EMSC

Illinois EMSC

SOFT TISSUE SWELLING Illinois EMSC

Illinois EMSC

EPIGLOTTITIS Immediate 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 Illinois EMSC

FOREIGN BODIES Food Small toys Other objects Illinois EMSC

Illinois EMSC

LOWER AIRWAY EMERGENCIES Asthma Bronchiolitis Pneumonia Pneumothorax Illinois EMSC

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 Illinois EMSC

INITIAL ASSESSMENT OF ASTHMA Assess Airway Auscultate breath sounds Evaluate work of breathing Illinois EMSC

ASTHMA ASSESSMENT Respiratory distress Severe anxiety Decreasing level of consciousness Tachypnea, tachycardia or bradypnea, bradycardia with impending respiratory failure Illinois EMSC

ASTHMA Illinois EMSC

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 Illinois EMSC

Illinois EMSC

EXPECTED OUTCOMES WITH ASTHMA Decreased respiratory distress Decreased work of breathing Improved air exchange Decreased anxiety Illinois EMSC

EVALUATION/FOLLOW UP WITH ASTHMA Record asthma attacks on student’s health record Follow up with primary health care provider Revise IEMP as needed Illinois EMSC

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) Illinois EMSC

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 Illinois EMSC

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 Illinois EMSC

PNEUMONIA Illinois EMSC

PNEUMONIA: SIGNS AND SYMPTOMS OLDER CHILDREN Cough Fever Pleuritic pain Dyspnea Tachypnea Illinois EMSC

PNEUMONIA SIGNS AND SYMPTOMS YOUNGER CHILDREN Fever Irritability Poor feeding Vomiting and diarrhea Apnea Illinois EMSC

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 Illinois EMSC

PNEUMOTHORAX CAUSES Trauma to chest Asthma Pneumonia Cystic fibrosis Illinois EMSC

Illinois EMSC

TYPES Simple pneumothorax Blunt or penetrating trauma Spontaneous pneumothorax Hemothorax Open pneumothorax Illinois EMSC

SIGNS AND SYMPTOMS Dyspnea Chest pain Decreasing breath sounds on affected side Agitation Illinois EMSC

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 Illinois EMSC

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 Illinois EMSC

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. Illinois EMSC

ANY QUESTIONS?? Illinois EMSC