Recognize Respiratory Distress or Failure

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PALS Recognize Respiratory Distress/Failure

Figure 11

In its simplest form, respiratory distress is a condition in which pulmonary activity is insufficient to bring oxygen to and to remove carbon dioxide from the blood. Challenge arises with the recognition of respiratory distress when the person appears to be breathing, but is not actually breathing effectively. Proper rate and depth of breathing is important to assess when evaluating whether the person is effectively breathing. The two main actions involved in breathing are ventilation and oxygenation. Consider the signs and symptoms presented below.

Ventilation
Is the airway clear? Are the muscles
of the chest
functioning?
Is the rate of
breathing
sufficient?
Ex. An obstructed
airway prevents
gas flow
Ex. Chest muscle
fatigue can occur
Ex. CNS
depression can
slow/stop breathing
Oxygenation
Is oxygen available? Is lung blood
flow adequate?
Can gases cross the
pulmonary
vasculature?
Ex. High altitudes
have low O2
Ex. Vascular shunts may not send blood
to lungs
Ex. Pulmonary
edema
or pneumonia

Abnormal breath sounds

STRIDOR • Upper airway obstruction (foreign body)
GRUNTING • Upper airway obstruction (Swollen airway)
• Pneumonia (grunting to recruit alveoli)
WHEEZING • Lower airway obstruction (Asthma)
CRACKLES • Fluid in lungs (Wet), Atelectasis (Dry)
ABSENT/DECREASED
BREATH SOUNDS
• Collapsed lung (air, blood)
• Lung tissue disease (pneumonia)

Table 11

Take Note

In some instances, breath sounds can provide information about the source of the breathing problem.

Causes of Respiratory Distress/Failure

Respiratory distress or failure generally falls into one of four broad categories (Table 12): upper airway, lower airway, lung tissue disease, and central nervous system (CNS) issues. This list is not comprehensive, and specific conditions should be addressed with specific therapy; but these represent the most common causes of respiratory distress or failure in a pediatric population.

UPPER AIRWAY LOWER AIRWAY LUNG TISSUE DISEASE CNS ISSUES
Croup (swelling) Bronchiolitis Pneumonia Overdose
Foreign body Asthma Pneumonitis Head trauma
Retropharangeal abscess Pulmonary edema
Anaphylaxis

Table 12

Pediatric Advanced Life Support (PALS) Course

Respiratory Distress/Failure

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