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RESPIRATORY OBJECTIVES

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

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RESPIRATORY OBJECTIVES

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  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 Illinois EMSC

  2. RESPIRATORY EMERGENCIES Illinois EMSC

  3. CAUSES OF RESPIRATORY EMERGENCIES • Infection • Trauma • Congenital conditions • Allergic conditions Illinois EMSC

  4. INCREASE IN CHRONIC RESPIRATORY CONDITIONS • Asthma • Pertussis • TB Illinois EMSC

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

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

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

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

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

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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 Illinois EMSC

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  15. 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 Illinois EMSC

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

  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 Illinois EMSC

  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 Illinois EMSC

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

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

  21. UPPER AIRWAY EMERGENCIES • CROUP • EPIGLOTTITIS Illinois EMSC

  22. 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) SIGNS AND SYMPTOMS OF CROUP AND EPIGLOTTITIS Illinois EMSC

  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 Illinois EMSC

  24. 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 Illinois EMSC

  25. 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

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  27. SOFT TISSUE SWELLING Illinois EMSC

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  29. 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 Illinois EMSC

  30. FOREIGN BODIES • Food • Small toys • Other objects Illinois EMSC

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  32. LOWER AIRWAY EMERGENCIES • Asthma • Bronchiolitis • Pneumonia • Pneumothorax Illinois EMSC

  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 Illinois EMSC

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

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

  36. ASTHMA Illinois EMSC

  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 Illinois EMSC

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

  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 Illinois EMSC

  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) Illinois EMSC

  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 Illinois EMSC

  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 Illinois EMSC

  44. PNEUMONIA Illinois EMSC

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

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

  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 Illinois EMSC

  48. PNEUMOTHORAX CAUSES • Trauma to chest • Asthma • Pneumonia • Cystic fibrosis Illinois EMSC

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

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