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 sats	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_figure12

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 (Heliox) Nebulizers (albuterol and ipratropium bromide) Corticosteroids Magnesium sulfate Epinephrine SQ Support breathing
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

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.