EMS World

JAN 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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BONUS CONTENT: THE PEDIATRIC AIRWAY 32 JANUARY 2019 | EMSWORLD.com W inter seems an appropriate time to delve into the world of pediatric respiratory dis- orders, specifically upper-air- way disorders, and snot. Yes, snot—kids are full of it, and it makes them laugh and giggle. The parents of the congested 1-month- old don't find it so funny. They cannot fig- ure out why nothing they do makes their baby better, and little do they know this could go on for weeks. Finally reaching their breaking point, they call EMS and enter the healthcare system. We r e m e m b e r f r o m o u r t r a i n i n g that kids are robus t and re silient. So w hy is respirator y dis tres s such a big deal? Respirator y distress is the lead- ing cause of cardiac arrest in children. Hy p oxic-a sphy xial arre s t is the m os t common cardiac arrest in children and frequently caused by air way obstruction or depressed respirator y drive. 1 Children will compensate for a long time, sometimes hours or days. Nonethe- less, when they finally crash, they crash hard and fast. At this point we are often behind the eight ball and have a tough time recovering. According to researchers led by the University of Pittsburgh's Eric- ka Fink, MD, the out-of-hospital cardiac arrest sur vival rate for children has mostly remained unchanged over the last several years, hovering in the 6%–10% range. 2 Initial Contact What does respirator y distress look like in children? They can have an elevated or decreased rate and an unusual respira- tor y pattern. Although we often caution students against using tachypnea as the sole indicator of respirator y distress, chil- dren in stressful situations often become tachypneic when excited. Here is where our a ssessment skills come into play: Use your door way assess- ment and the pediatric assessment tri- angle and take note of the quality of their breathing. We often note nasal flaring and abnormal breath sounds such as wheez- ing and stridor. If their presentation is more toxic, we can often hear them from out side the room or notice significant retrac tions and abnormal positioning, such as a tripod position in an attempt to keep their air way open. When you approach a child in respi- rator y distress, get down on their level and approach slowly. Use a parent to ea se access, so the child doesn't feel you're a threat. Tr y to use a calm, sooth- ing approach and continue your visual and audible assessment without laying hands on them. What do you see and hear? Retractions of ten appear above the clavicles, tugging at the trachea, with the intercostal muscles, and in genuinely severe cases we might think their sternum is going to touch their spine. With the help of a parent, tr y to get the child's shir t open or of f for a proper visual inspection of their chest. Listen for lung sounds first without a stethoscope By Roger Smith, NRP CRASHING HARD & FAST Respiratory distress is a big deal—bigger when you're a kid

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