1. 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
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2. RESPIRATORY EMERGENCIES
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3. CAUSES OF RESPIRATORY EMERGENCIES
Infection
Trauma
Congenital conditions
Allergic conditions
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4. INCREASE IN CHRONIC RESPIRATORY CONDITIONS
Asthma
Pertussis TB
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5. FAILURE TO RECOGNIZE AND TREAT RESPIRATORY DISTRESS CAN LEAD TO CARDIAC FAILURE AND DEATH!!!
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6. ANATOMIC AND PHYSIOLOGIC DIFFERENCES
CNS Control of Breathing
Airway
Chest wall differences
Respiratory muscles
Lung tissue
Gas Transport
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9. PREDISPOSING CONDITIONS
Allergies
Asthma
Cardiac Anomalies
Cystic Fibrosis
Smoking
Immunodeficiencies
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10. EQUIPMENT NEEDS Basic First-Aid Body fluid isolation supplies
Stethoscope
Peak flow meters
Epinephrine 1:1000
Protocols with phone numbers
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11. ASSESSMENT HISTORY PHYSICAL ASSESSMENT A B C's CIAMPEDS ABC's
Signs and symptoms of respiratory distress
A B C's
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13. 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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15. 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
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16. Signs of Respiratory Distress
NOTE:
Cyanosis is a
late sign of
respiratory
distress
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17. 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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18. 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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19. TRIAGE AND TRANSPORT URGENT
Student with chronic condition and/or
is in mild distress
Decreased air movement (minimal)
Mild retractions
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20. TRIAGE AND TRANSPORT NON-URGENT
No signs or symptoms of distress
Breath sounds normal
Color normal
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21. UPPER AIRWAY EMERGENCIES
CROUP
EPIGLOTTITIS
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22. 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
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23. 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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24. 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
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25. EPIGLOTTITIS Life-threatening bacterial infection of the epiglottis
Most often caused by Haemophilus influenzae type B
Most commonly seen in children age years, however with immunization compliance, older children and young adults are more commonly affected
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27. SOFT TISSUE SWELLING
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29. 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
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30. FOREIGN BODIES
Food
Small toys
Other objects
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32. LOWER AIRWAY EMERGENCIES
Asthma
Bronchiolitis
Pneumonia
Pneumothorax
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33. 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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34. INITIAL ASSESSMENT OF ASTHMA
Assess Airway
Auscultate breath sounds
Evaluate work of breathing
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35. ASTHMA ASSESSMENT Respiratory distress Severe anxiety
Decreasing level of consciousness
Tachypnea, tachycardia or bradypnea, bradycardia with impending respiratory failure
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36. ASTHMA
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37. 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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39. EXPECTED OUTCOMES WITH ASTHMA
Decreased respiratory distress
Decreased work of breathing
Improved air exchange
Decreased anxiety
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40. 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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41. 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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42. 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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43. 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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44. PNEUMONIA
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45. PNEUMONIA: SIGNS AND SYMPTOMS
OLDER CHILDREN
Cough
Fever
Pleuritic pain
Dyspnea
Tachypnea
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46. PNEUMONIA SIGNS AND SYMPTOMS
YOUNGER CHILDREN
Fever
Irritability
Poor feeding
Vomiting and diarrhea
Apnea
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47. 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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48. PNEUMOTHORAX CAUSES Trauma to chest Asthma Pneumonia Cystic fibrosis
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50. TYPES Simple pneumothorax Blunt or penetrating trauma
Spontaneous pneumothorax
Hemothorax
Open pneumothorax
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51. SIGNS AND SYMPTOMS Dyspnea Chest pain
Decreasing breath sounds on affected side
Agitation
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52. 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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53. 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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54. 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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55. ANY QUESTIONS??
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