Respiratory distress

From Guide to YKHC Medical Practices

All Emergency RMT.png

Pediatric Critical Care Guide


add epi nebs

Adult

While assuring that the patient has sufficient supplemental O2 available in the clinic, inquire if he/she normally has Home O2, is an Expected Home Death or Palliation patient to better meet both the needs and planned desires of this patient. Once full treatment of the patient is established, at least one trial of a nebulized bronchodilator with clinical progression of treatment as is indicated. Consider PO prednisone 40-60 mg x1 for broncho-constricted adult patients. Also consider medevac if after a trial of treatment, spO2 remains <90% or moderate to severe respiratory distress persists.

Peds

Wheezing

  • Give Two back-to-back albuterol nebs
  • O2 administered –preferably with NC, but blow by ok to start with
  • If patient is febrile, give Tylenol and/or Motrin
  • Find out who else is helping the CHAs, where the patient is and patient’s name and DOB
  • Make sure the CHA calls for at least two more people to help.
  • Move patient to clinic if they are at home or another site
  • Make sure bag and good fitting mask is available
  • Get patient information to look up past history medications etc
  • Frequent reassessment and keep good documentation of times and interventions
  • If patient improves with these interventions then reassess O2 requirement, RR and WOB.
  • Consider close monitoring and possibly regular flight to Bethel

OR

  • Activate medevac if not improving
  • VTC video monitoring if able
  • Increase nasal cannula O2 to 3-5 L as needed
  • Frequent nebs or continuous Albuterol if required
  • Try Atrovent nebs or racemic or nebulized epinephrine (IV solution)
  • Call peds or a pediatric partner for help
  • Consider prednisone 2mg/kg of crushed tablet in liquid/pudding or syrup.

Stridor at Rest

Remember Supportive Measures

  • Keep child upright
  • May take child outside for cool air
  • Minimize invasive measures – keep child CALM!
  • Do NOT give albuterol; this can worsen croup
  • May give NS neb

Activate a medevac immediately if patient develops signs or symptoms of severe croup or impending airway obstruction: drooling, lethargy, tripod position, marked retractions, tachycardia, cyanosis or pallor


Emergency RMT Scenarios and Responses