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Illinois EMSC1 Upon completion of this lecture, you will be better able to: Define the most common types of respiratory emergencies in school-aged children.

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Presentation on theme: "Illinois EMSC1 Upon completion of this lecture, you will be better able to: Define the most common types of respiratory emergencies in school-aged children."— Presentation transcript:

1 Illinois EMSC1 Upon completion of this lecture, you will be better able to: Define the most common types of respiratory emergencies in school-aged children List the steps in assessing a child who is experiencing respiratory distress Describe the proper interventions for selected respiratory emergencies RESPIRATORY OBJECTIVES

2 Illinois EMSC2 RESPIRATORY EMERGENCIES

3 Illinois EMSC3 CAUSES OF RESPIRATORY EMERGENCIES Infection Trauma Congenital conditions Allergic conditions

4 Illinois EMSC4 INCREASE IN CHRONIC RESPIRATORY CONDITIONS Asthma Pertussis TB

5 Illinois EMSC5 FAILURE TO RECOGNIZE AND TREAT RESPIRATORY DISTRESS CAN LEAD TO CARDIAC FAILURE AND DEATH!!!

6 Illinois EMSC6 ANATOMIC AND PHYSIOLOGIC DIFFERENCES CNS Control of Breathing Airway Chest wall differences Respiratory muscles Lung tissue Gas Transport

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9 9 PREDISPOSING CONDITIONS Allergies Asthma Cardiac Anomalies Cystic Fibrosis Smoking Immunodeficiencies

10 Illinois EMSC10 EQUIPMENT NEEDS Basic First-Aid Body fluid isolation supplies Stethoscope Peak flow meters Epinephrine 1:1000 Protocols with phone numbers

11 Illinois EMSC11 ASSESSMENT HISTORY CIAMPEDS PHYSICAL ASSESSMENT ABC's Signs and symptoms of respiratory distress

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13 Illinois EMSC13 SIGNS AND SYMPTOMS OF RESPIRATORY DISTRESS RESPIRATORY RATE –Increased early, decreased late –NOTE: A SLOW RESPIRATORY RATE IS AN OMINOUS SIGN IN CHILDREN RESPIRATORY OBSERVATIONS –Nasal flaring –Retraction USE OF ACCESSORY MUSCLES COUGHING

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15 Illinois EMSC15 SIGNS & SYMPTOMS Abnormal Breath Sounds –Wheezing - hallmark sign of lower airway obstruction –Inspiratory Stridor - hallmark sign of upper airway obstruction –Decreased, absent, unequal breath sounds –Expiratory Grunting - LATE sign Color –Cyanosis is a late sign Level of consciousness –Somnolence/lethargy is a late sign

16 Illinois EMSC16 Signs of Respiratory Distress NOTE: Cyanosis is a late sign of respiratory distress

17 Illinois EMSC17 PLAN AND INTERVENTIONS Maintain position of comfort Deliver oxygen if available Avoid procedures that might agitate the student Reassure the student Administer standing order medications Transport

18 Illinois EMSC18 TRIAGE AND TRANSPORT EMERGENT Signs and symptoms of severe distress and impending failure: –Cyanosis, lethargy, or agitation –Absent or severely decreased breath sounds –Apnea, bradycardia, severe retractions, or grunting

19 Illinois EMSC19 TRIAGE AND TRANSPORT URGENT Student with chronic condition and/or is in mild distress – Decreased air movement (minimal) – Mild retractions

20 Illinois EMSC20 TRIAGE AND TRANSPORT NON-URGENT No signs or symptoms of distress Breath sounds normal Color normal

21 Illinois EMSC21 UPPER AIRWAY EMERGENCIES CROUP EPIGLOTTITIS

22 Illinois EMSC22 SIGNS AND SYMPTOMS OF CROUP AND EPIGLOTTITIS CROUP –Gradual onset –Barky cough –Low grade fever –Hoarse voice –Inspiratory stridor –Other signs/symptoms depend on distress EPIGLOTTITIS –Sudden onset –Muffled cough less prominent –High fever –Inspiratory stridor –Difficulty swallowing –Tripod positioning –Drooling (not always)

23 Illinois EMSC23 CROUP Inflammation of area around vocal cords and trachea Commonly caused by parainfluenza virus Occurs mostly in children 3 months to 3 years of age More prevalent in cooler months

24 Illinois EMSC24 CROUP IMMEDIATE INTERVENTIONS Mild distress Notify parent/guardian and/or physician Observe for worsening of distress Moderate to severe distress Cold steam from vaporizer, cold air, or steam from hot water faucets Call EMS, notify parent/guardian and physician

25 Illinois EMSC25 EPIGLOTTITIS Life-threatening bacterial infection of the epiglottis Most often caused by Haemophilus influenzae type B Most commonly seen in children age 2-6 years, however with immunization compliance, older children and young adults are more commonly affected

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27 Illinois EMSC27 SOFT TISSUE SWELLING

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29 Illinois EMSC29 EPIGLOTTITIS Immediate Interventions TREAT AS EMERGENT!!!! Call EMS and arrange for immediate transport DO NOT MANIPULATE AIRWAY! Do not upset the student Apply oxygen, if available and if the student will tolerate

30 Illinois EMSC30 FOREIGN BODIES Food Small toys Other objects

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32 Illinois EMSC32 LOWER AIRWAY EMERGENCIES Asthma Bronchiolitis Pneumonia Pneumothorax

33 Illinois EMSC33 ASTHMA Recurrent and reversible airway obstruction Status asthmaticus - Severe airway obstruction that is life-threatening Caused by allergens and other factors Risk factors include prior intubation, multiple hospital stays, and use of steroids

34 Illinois EMSC34 Assess Airway Auscultate breath sounds Evaluate work of breathing INITIAL ASSESSMENT OF ASTHMA

35 Illinois EMSC35 ASTHMA ASSESSMENT Respiratory distress Severe anxiety Decreasing level of consciousness Tachypnea, tachycardia or bradypnea, bradycardia with impending respiratory failure

36 Illinois EMSC36 ASTHMA

37 Illinois EMSC37 INTERVENTIONS FOR ASTHMA Reassure student Measure Peak Flow –Green (80% - 100% of personal best) –Yellow (50% - 80% of personal best) –Red (< 50% of personal best) Administer medications per protocol

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39 Illinois EMSC39 EXPECTED OUTCOMES WITH ASTHMA Decreased respiratory distress Decreased work of breathing Improved air exchange Decreased anxiety

40 Illinois EMSC40 EVALUATION/FOLLOW UP WITH ASTHMA Record asthma attacks on student’s health record Follow up with primary health care provider Revise IEMP as needed

41 Illinois EMSC41 Asthma Tips Teach students to avoid asthma triggers Keep medications available Obtain thorough assessment of students with respiratory distress and complete asthma histories (history should include prior hospitalizations and intubations )

42 Illinois EMSC42 BRONCHIOLITIS Viral disease, affects children under the age of one year Respiratory Synctial Virus (RSV) most common cause History of runny nose and cough, poor fluid intake

43 Illinois EMSC43 PNEUMONIA Pneumonia is an infection of the lower respiratory tract CAUSES –Infants and preschool children: viruses likely –School-aged children: Mycoplasma more common than viruses –NOTE: TB pneumonia is reappearing

44 Illinois EMSC44 PNEUMONIA

45 Illinois EMSC45 PNEUMONIA: SIGNS AND SYMPTOMS OLDER CHILDREN –Cough –Fever –Pleuritic pain –Dyspnea –Tachypnea

46 Illinois EMSC46 PNEUMONIA SIGNS AND SYMPTOMS YOUNGER CHILDREN Fever Irritability Poor feeding Vomiting and diarrhea Apnea

47 Illinois EMSC47 IMMEDIATE INTERVENTIONS Assess degree of distress Contact EMS for severe distress Contact parent/guardian for mild distress; child may need MD evaluation Continually evaluate for worsening of symptoms

48 Illinois EMSC48 PNEUMOTHORAX CAUSES –Trauma to chest –Asthma –Pneumonia –Cystic fibrosis

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50 Illinois EMSC50 TYPES Simple pneumothorax –Blunt or penetrating trauma –Spontaneous pneumothorax Hemothorax Open pneumothorax

51 Illinois EMSC51 SIGNS AND SYMPTOMS Dyspnea Chest pain Decreasing breath sounds on affected side Agitation

52 Illinois EMSC52 SPECIAL NEEDS CHILDREN Congenital heart disease Cystic fibrosis Conditions affecting the immune system Children with artificial airways Children requiring oxygen Children with physical deformities Children with seizures

53 Illinois EMSC53 PREVENTION Be aware of children with allergies Provide medical-alert bracelets Ensure teachers and other support staff receive CPR and First Aid training Have proper equipment in schools Be aware of treatment plans Encourage immunizations Teach parents/guardians about relationship between smoking and respiratory distress Make all school areas non-smoking

54 Illinois EMSC54 SUMMARY Respiratory illnesses are common in preschoolers and school-aged children and is partly due to the unique anatomic and physiologic factors that increase their susceptibility to respiratory problems. Left untreated, respiratory distress can lead to respiratory failure and cardiopulmonary arrest.

55 Illinois EMSC55 ANY QUESTIONS??


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