UNCONTROLLED WHEN PRINTED

Definition:

Respiratory distress is a potentially life-threatening emergency.  There are many causes of respiratory distress therefore the Ambulance Officer should attempt to differentiate through appropriate assessment and history taking. If you are unable to differentiate the cause of the respiratory distress, the proper management is to administer High Concentration Oxygen and transport in a position of comfort.

Information Needed:

History:

  • Onset: fast or slow, slow or rapid deterioration.
  • Activity at the time of onset.
  • Relevant past medical history: chronic lung or heart problems; relevant medications; home oxygen; previous hospitalisations.
  • Allergies?
  • Associated symptoms: chest pain.
  • Emotional distress.

Common Causes:

Signs and Symptoms:

  • Shortness of breath, laboured breathing.
  • Anxiety.
  • Pale and/or cyanosis.
  • Abnormal breath sounds: stridor, wheeze, wet, crackles.
  • Increased respiratory effort: Use of accessory muscles.
  • Speech: full sentences, phrases, words or nil.

Paediatric-specific Dyspnoea

CroupEpiglottitis
Age6 months  - 4 years of ageOver 3 years, can effect adults
Time of DayOften worse at nightNone specific
OnsetGradual - often associated with a cold or other viral infectionRapid (hours)
Appearance / PositionVariablePale complexion, may be postured with neck extended into the sniffing position, with lower jaw protrusion
FeverModerate <38°oCHigh >38.5°C
Breath SoundsInspiration stridorSoft expiratory stridor or soft snore
CoughBarking "seal" coughMinimal or absent
SpeechHoarse voice (sore throat)Minimal or unable to speak
SwallowingAble to swallowPain upon swallowing, evolving to inability to swallow
Severe Signs & Symptoms
  • Agitated, distressed or lethargic, decreased level of consciousness.
  • Increased stridor.
  • Cyanosis and marked pallor are late signs of life-threatening airway obstruction.
  • Drooling - a very serious sign
  • High temperature

General Principles:

  • Do not make the child more upset or anxious as this will further compromise the airway.
  • Administer oxygen carefully to avoid upsetting the child.
  • Children achieve higher Oxygen concentrations because of lower inspiratory rate, tidal volume, and dead space. Even a therapy mask can give 60 — 70% Oxygen in a child.
  • Children with croup, epiglottis or laryngeal oedema who develop respiratory arrest, usually do so due to exhaustion or spasm. You will still be able to ventilate gently with appropriate bag-valve-mask, mouth-to-mask or mouth-to-mouth.
  • Sudden complete obstruction due to epiglottitis may respond to tipping the child steeply head down, and using back-blows to dislodge the swollen epiglottis. 

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