4-9 PEDIATRIC RESPIRATORY DISTRESS

EMR - Emergency Medical Responder

1. Establish patient responsiveness. If cervical spine trauma is suspected, manually stabilize the spine.
2. Assess the patient’s airway for patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
3. Open the airway via chin lift or modified jaw thrust.
4. Suction as necessary
5. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
6. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a BVM device with 100% oxygen, if available, and begin chest compressions if heart rate <60 beats per minute despite oxygenation and ventilation.
7. If chest rise indicates inadequate ventilation, reposition airway and reassess. If inadequate chest rise is noted after repositioning of airway, suspect foreign body obstruction and refer to appropriate protocol for management.
8. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
9. Call for ALS intercept if any signs of respiratory distress or failure are present.
10. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
11. Assess circulation and perfusion

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Assess patient breathing, including mental status, rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. If bronchospasm is present or patient has a history of asthma with respiratory distress:
   1. Administer patient’s prescribed hand-held, metered-dose inhaler as appropriate; 1 or 2 puffs if maximum dose not already taken prior to EMS arrival
   2. Administer albuterol (Ventolin) 2.5 mg with or without ipratropium (Atrovent) 500 mcg via nebulizer; May repeat once if no relief
   3. If patient is in significant respiratory distress, treatment may be initiated prior to contact of Medical Control, but Medical Control should be contacted as soon as patient care safely allows to discuss continuing treatment.
3. If patient exhibits stridor or epiglottitis is suspected, do not attempt to look in mouth, allow the patient to sit in a position of comfort, provide supplemental 100% oxygen and begin immediate transport.
4. Initiate rapid transport and Contact MEDICAL CONTROL to request ALS intercept.
5. Apply ECG monitor & run strip if trained to do so, time allows and after all other interventions are completed.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Assess patient breathing, including rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Contact MEDICAL CONTROL for orders regarding need for vascular access and rate of fluid administration.

Intermediate - Perform/Confirm All Above Interventions

1. If airway cannot be maintained by other means, or if prolonged assisted ventilation is anticipated, perform endotracheal intubation.
2. Contact MEDICAL CONTROL If patient continues with respiratory distress with bronchospasm despite albuterol, consider administration of 0.01 mL/kg of 1:1,000 epinephrine subcutaneously (up to a total dose of 0.3 mg)
3. If patient does not respond discuss possibility of epinephrine nebulizer with Medical Control.
4. Evaluate for narcotic overdose based on medications, history and pupillary exam. Treat as indicated with naloxone (Narcan) 0.1mg/kg IV/IO/IN per dose.  Repeat as needed up to 2 mg.  Titrate primarily to ensure adequate ventilation, airway control and to maintain a systolic BP >90.

Paramedic - Perform/Confirm All Above Interventions