One of the scariest calls you will run into is a child in respiratory distress. Children are challenging, with their inability to articulate symptoms; their small veins and airways; and the fact that when they crash, they crash with a vengeance.
Speed is of the essence when treating pediatric respiratory disorders. You must identify the problem, rapidly formulate a game plan, and implement it immediately. And when it comes to maintaining airway patency, your battery-operated aspirator plays a fundamental role in pediatric emergencies.
So, let's start at the beginning, with some of the primary causes of respiratory distress in children. They include:
- Airway obstruction
- Restriction of chest wall movement
- Chest wall muscle fatigue
- Decrease in central respiratory drive
- Chest trauma
Kids are prone to certain respiratory disorders, and parents, especially those with multiple children, are usually informed about common childhood illnesses. They include:
There are afew key indicators that should raise your index of suspicion, especially in asthmatics. There are several important questions to ask the parent or guardian. Be sure to ask about:
- Prior stays in the intensive care unit
- Prior intubations
- If the child has had more than three ED visits in the last year
- If the child has had more than two hospital admissions in the last year
- Use of more than one inhaler canister in the past month
- Prior use of steroids
- Bronchodilators used every four hours or more
- No response to aggressive home therapy
Look for the Signs
The signs of respiratory distress in children can be subtle, especially if you are not accustomed to treating pediatrics. Signs and symptoms of respiratory distress include:
- Rapid or labored breathing
- Nasal flaring
- Use of accessory muscles
- Abnormal breath sounds
- Positioning (tripod)
If the child is too tired to answer questions, he or she is in bad shape! However, avoid overinterpreting low oxygen saturation in children—compare the reading to your physical findings and use capnography to monitor adequacy of ventilations. As respiratory distress deteriorates, the signs will intensify, eventually leading to failure and arrest if not corrected. This is when your battery-powered aspirator can be truly effective.
If the distress is caused by excessive mucus, bleeding, or vomitus in the airway, your suction unit can reverse the obstruction and reestablish patency. The important point to keep in mind is that ONLY suction can effectively clear the airway. No other piece of equipment in your EMS arsenal can remove excessive bodily fluids from the oral or nasal cavity. This is why it’s imperative that portable suction be brought to every pediatric call.
Selecting the Appropriate Catheter
Larger children and teens may accommodate a normal, rigid catheter for suctioning. The small tip on such catheters will allow you to navigate their mouths, while being careful to avoid traumatizing tissues. But small children and infants will require a small, flexible catheter.
Suctioning the Pediatric Patient
Suctioning a child is similar to suctioning an adult. Your equipment must be ready and functional, you must have the appropriate-sized catheter on hand, and you must follow the normal guidelines to prevent hypoxia—mainly limiting suction time to under five seconds.
However, because of their smaller oral and nasal cavities and the delicacy of their tissues, children must be approached with added caution when suctioning. Possible complications include:
- Injury to the mouth, upper/lower airway, or lungs
- Inducing gagging or vomiting, especially in conscious patients
- Aspiration of stomach contents
- Hypoxia secondary to prolonged suction
- Forcing a foreign body deeper into the airway with the suction catheter
- Increased intracranial pressure
Suctioning small children or infants with a flexible catheter also requires a careful approach. Here are the guidelines:
- Suction the mouth first, then the nose
- Advance the catheter until the tip contacts secretions
- Block the side port with your thumb and begin suctioning using a twisting motion
- Do not suction beyond your direct vision to avoid gagging, vomiting, or aspiration
- Insert the catheter into the nose and follow the same technique by applying suction, removing with a twisting motion
Sick children can be intimidating, but you have the necessary tools and know-how to help them. And your battery-powered aspirator plays a fundamental role in treating pediatric emergencies.
American Academy of Pediatrics, Pediatric Education for Prehospital Professionals (Jones & Bartlett, 2014).