Recognising the child with respiratory distress

Jamie Ranse: Critical Care Education Coordinator, Staff Development Unit, ACT Health.

RECOGNISING THE CHILD WITH RESPIRATORY DISTRESS

• Effort of breathing• Efficacy of breathing• Effects of respiratory inadequacy• Respiratory status assessment• Respiratory alterations management

overview

• Respiratory Rate• Recession

– Mild: sub-costal– Severe: sternal

• Accessory muscle use• Grunting• Alar nasal flare• Child’s position• Respiratory noises

– Stridor / wheeze

effort of breathing

effort of breathing: respiratory rate

Age (yrs) Resp Rate (breathes/min)

<1 30-40

2-5 25-30

5-12 20-25

>12 15-20

effort of breathing: breath sounds

• Inspiratory stridor– upper airway pathology

• Expiratory wheeze– lower airways pathology

Exhaustion is a pre-terminal sign

• Chest expansion• Air entry• Pulse oximetry

efficacy of breathing

A silent chest is a pre-terminal sign

• Heart rate• Skin colour• Level of consciousness

Pre-terminal signs:• Bradycardia• Central cyonosis• Unconsciousness

effects of respiratory inadequacy

respiratory status assessment

respiratory alterations management

• Airway obstruction• Swelling• Bronchospasm• Pulmonary oedema• Non-specific respiratory disease• Hyperventilation due to anxiety