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In this lesson, we're going to cover upper airway respiratory distress, including causes, signs and symptoms, treatment options in general, and some information on the best courses of treatment for a few specific causes of respiratory distress in pediatric patients.
Respiratory distress is an important subject to cover, and it's important to note that upper airways obstructions can present mild to severe symptoms and include the large airway anatomy – such as the nose, pharynx, and larynx.
Because children and infants have much smaller airways than adults, they are more susceptible to these types of obstructions. Remember, a child's trachea is roughly the size of their pinky finger.
Pro Tip #1: Also, in children and infants with a decreased level of consciousness, the tongue itself can cause the obstruction, because when the muscles relax, the tongue can fall to the back of the throat and obstruct the oral pharynx part of the airway.
There are several common causes of upper airway respiratory distress in pediatric patients, and these include:
And less common causes include:
The signs and symptoms of upper airway obstructions are different than those for lower airway obstructions, as they occur mostly during inspiration and include:
Usually, as upper airway obstructions worsen, breathing will become more labored and faster.
Pro Tip #2: However, it's important to note that in the later stages with severe hypoxia, breathing becomes slower and will eventually stop altogether if left untreated.
Early recognition, identification, and treatment of respiratory distress in infants and children is vital to achieve a good outcome and also for their survival, as respiratory distress can quickly progress into respiratory failure and cardiac arrest.
Treatments for specific causes will often vary, however there are some general methods used to treat a child in respiratory distress, and these include:
It's also important to identify and treat specific types or causes of upper airway obstruction based on the patient's signs and symptoms.
Croup is most commonly identified by:
For treating croup, administer nebulized epinephrine at 5ml of 1:1000 as indicated. And after initial airway treatment has been initiated, establish IV or IO access to administer corticosteroids if required.
A commonly recommended corticosteroid for croup is dexamethasone at .6mg/kg delivered via IV or IO.
Pro Tip #3: It's important to reassess the patient's vitals after the initial treatment and continue to monitor them closely. You should also be prepared to intubate if respiratory failure occurs.
For pediatric patients with anaphylaxis, treat with intramuscular epinephrine, as this is considered the first course of treatment for this condition.
Depending on the patient's specific signs and symptoms, you should also consider:
If the patient has a foreign body obstruction, where they cannot cough or breathe, that obstruction must be removed immediately with proper basic life support.
Techniques you can use to remove an obstruction are:
For mild cases of foreign body obstructions, you'll recognize this as the child will still be able to make sounds, like coughing forcefully.
Pro Tip #4: Do not try to physically remove the obstruction in these cases. Instead, call for expert consultation, if time allows. And if the patient's status remains stable, you should still see if surgical intervention or deep suctioning is required.
Always remember to allow the infant or child to remain in the most comfortable position possible and always monitor them closely for deteriorating symptoms. And if they do deteriorate, treat them accordingly.