From transportation to lunchtime and recess, school safety is at the forefront this time of year — and with the COVID-19 pandemic extending into another fall, it creates an added layer of concern.
But respiratory diseases and incidents that can block a child’s airway have long been among the most common types of emergencies to strike at school. Depending on the severity of these situations, treatment may include intubation — a procedure which comes with risks of its own.
Let’s take a look at common pediatric respiratory problems and the key to effective and safe intubation.
Allergies and anaphylactic shock
Food allergies, such those caused by ingesting or being exposed to nuts, are common. These must be taken very seriously, because severe allergic reactions can be potentially life-threatening. In a condition known as anaphylaxis, the patient’s body releases a flood of chemicals that cause them to go into anaphylactic shock with a range of symptoms that may include throat tightening, shortness of breath, trouble swallowing and a swelling of the lips or tongue — any of which can cause aspiration or choking.
As children share lunches or are unintentionally exposed to a food they are allergic to, anaphylaxis is a regular risk at schools. Several other factors can lead to the condition, including insect stings or medicines. Schools are mindful of this and most keep on hand doses of epinephrine, the most common treatment, and students’ parents may even provide the school with auto-injector syringes of the drug.
Even after epinephrine is administered, emergency treatment is recommended. In some cases, a child may aspirate on food they were consuming, or the treatment may not be as effective as expected, making it necessary to clear the airway.
Flu and respiratory illnesses
Influenza is expected to make a comeback this year, if data from the Southern hemisphere is any indication. Australia has had an early and severe flu season as people have dropped COVID-19 mitigation measures.
Although flu is more dangerous for children 5 years old or younger, it can be dangerous for any age group, especially if an individual has an existing health problem, such as asthma, chronic lung disease, obesity or a neurologic condition.
While most cases of flu can be classified as mild, it can lead to serious respiratory complications, including pneumonia and even multi-organ failure. Someone experiencing these extreme complications may require emergency treatment and intubation.
Millions of Americans live with asthma, a condition in which the airway narrows and swells, leading to labored breathing, coughing and wheezing. If symptoms don’t abate with regular home treatment (typically, medication delivered in a rescue inhaler), patients may need to seek out emergency treatment. Should further medications fail and a patient begins to show signs of hypoxia, low oxygen levels in the blood, intubation may be appropriate.
The emergence of more contagious variants of COVID-19 has coincided with higher rates of hospitalization of children. As students return to schools with varying mask requirements that trend may not end anytime soon. And even though a COVID vaccine was approved for even very young children, vaccination rates vary by state.
Although the new variants are more infectious, much of the advice and guidance surrounding the coronavirus holds up and applies to pediatric patients. Emergency personnel must be informed on the importance of airway management for COVID-19 patients. There are also specific recommendations regarding pediatric COVID-19 patients.
Pediatric intubation and suction
Pediatric intubation can be frightening for patients, parents and caregivers alike, to say nothing of the inherent risks that come with the procedure at any age. Blood in the airway and airway edema, for example, are the two most significant predictors of intubation failure, and it can also be dangerous to perform in patients who are at risk of aspiration. Additionally, pediatric patients have different considerations pertaining to tube size and pre-intubation suctioning power.
SSCOR’s hospital and EMS products provide the flexibility that allows for safe, effective suctioning ahead of intubation for pediatric patients. When it comes to the most vulnerable patients, only the best solutions will suffice.
Editor's Note: This blog was originally published in September 2021. It has been re-published with additional up-to-date content.