Respond to Respiratory Distress/Failure

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INITIAL MANAGEMENT OF RESPIRATORY DISTRESS/FAILURE
Airway Open and support the airway Suction Consider advanced airway
Breathing Monitor O2 stats Supplemental O2 Nebulizers
Circulation Monitor vitals Establish vascular access

Table 13

Take Note

If a person has a medication patch on their chest, remove it before applying the AED pads. Also, if there is a bulge under the skin of their chest, a pacemaker may be present. Avoid placing the AED pads over this device and adjust placement accordingly. If the AED malfunctions or does not work, continue performing CPR until additional help arrives.

PALS management of respiratory distress/failure is adjusted based on the severity of the current condition. For example, mild asthma is treated with bronchodilator inhalers, but severe asthma (status asthmaticus) may require ET intubation. The provider must continually assess the person’s current needs and adjust care accordingly.

Croup Management

PALS Croup Management

Figure 12

Upper Airway Lower Airway
Cause Treatment Cause Treatment
CROUP
  • Dexamethasone
  • Oxygen (Heliox)
  • Nebulizer (epinephrine)
  • Intubate
  • Tracheostomy
 BRONCHIOLITIS
  • Suctioning
  • Nebulizers
FOREIGN BODY
  • Dexamethasone
  • Oxygen (Heliox)
  • Nebulizer (epinephrine)
  • Intubate
  • Tracheostomy
 ASTHMA
  • Oxygen
  • Nebulizers (albuterol and ipratropium bromide)
  • Corticosteroids
  • Magnesium sulfate
  • Epinephrine SQ
  • Support breathing
  • Iteliox
ANAPHYLAXIS
  • Epinephrine IM
  • Nebulizer
  • Diphenhydramine
  
Lung Tissue Disease CNS Issues
Cause Treatment Cause Treatment
PNEUMONIA
  • Dexamethasone
  • Oxygen (Heliox)
  • Nebulizer (epinephrine)
  • Intubate
  • Tracheostomy
 OVERDOSE
  • Naloxone (opioid reversal)
  • Antidotes
  • Support breathing
PNEUMONITIS
  • Antibiotics (bacterial)
  • Nebulizers
  • Support breathing
 TRAUMA
  • Neurosurgery
  • Reduce intracranial pressure
  • Support breathing
PULMONARY EDEMA
  • Diuretics
  • Inotrope
  • Support breathing
 OVERDOSE

Table 14

Take Note
  • In general, providers commonly work from the least to the most
    invasive intervention (top to bottom).
  • If the person presents with severe distress, proceed directly to maneuvers that are more aggressive.
  • Albuterol is the most common medication used via nebulizer to cause bronchodilation.
  • Common causes of acute community-acquired pneumonia include Streptococcus pneumonia, Mycoplasma pneumonia, Haemophilus influenza, and Chlamydia pneumonia.
  • High fever is the most common cause of quiet tachypnea.

Pediatric Advanced Life Support (PALS) Course

Respiratory Distress/Failure

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