Paediatrics: Respiratory distress -Management
Respiratory drive: pattern and timing of breathing may reflect a central or brainstem cause.
Respiratory distress: management
Assess the patient for the following:
- Colour: pallor or cyanosis.
- Respiratory drive: pattern and timing of breathing may reflect a central brainstem cause.
- Inspiration and expiration of air at the mouth and nose: upper airway obstruction produces stridor; lower airway obstruction leads to cough, wheeze, and a prolonged expiratory phase.
- Chest wall movement: chest and abdominal wall dynamics may indicate flail-chest, diaphragmatic palsy, pneumothorax, or foreign body inhalation.
- Position and level of agitation.
- Mental state.
- Heart rate and perfusion: these may reflect impending arrest.
- Non-invasive: pulse oximetry measurement of oxyhaemoglobin saturation, pulse oximetry measurement of oxyhaemoglobin saturation (SpO2).
- Arterial blood gas: assessment of acid-base, PaO2, PaCO2. A capillary blood sample is a good alternative (for pH, PCO2) if the extremity is warm and the blood flows freely.
- Blood tests: full blood count (FBC), electrolytes, glucose, and cultures.
- CXR: for diagnosis (e.g. severe pneumonia); for assessment ofcomplications (e.g. pulmonary oedema, pneumothorax).
- Pulse oximetry.
- Continuous ECG.
- Fluid balance.
- Conscious level.
There are specific therapies for each condition listed in the ‘Differential diagnoses’. With regard to fluid therapy, we generally restrict total volume to 80% maintenance for the following reasons.
- Distress with retraction: high –ve intrathoracic pressure will pull fluid out of capillaries into the interstitial space and will aggravate breathing with pulmonary oedema.
- Syndrome of inappropriate antidiuretic hormone (SIADH): this is a common problem in moderate to severe respiratory distress.
- Diuresis is limited: in the hydrated patient consider using furosemide(0.5–1mg/kg, IV). It may help the patient with extra-interstitial water without overt oedema.