Prehospital Pediatric Respiratory Distress

Episode 11: Prehospital Pediatric Respiratory Distress

Brought to you by The National Association of EMS Physicians (NAEMSP) and Missouri Emergency Medical Services for Children (MO-EMSC).

Hosts: Dr. Joelle Donofrio-Odmann and Dr. Joseph Finney

Website: https://sites.libsyn.com/414020 

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Content Experts: Joelle Donofrio-Odmann, DO and Joseph Finney, MD

Overview:
This podcast episode focuses on pediatric respiratory distress in prehospital settings, providing key insights for EMS providers to assess and manage these cases effectively. Dr. Joelle D’Onofrio-Odman emphasizes the importance of recognizing early signs of respiratory failure and understanding pediatric anatomy, which makes young children more vulnerable to airway obstruction. The episode introduces practical tools, such as the Pediatric Assessment Triangle, to differentiate distress from failure and ensure timely interventions.

Highlighted Teaching Points

• Pediatric Respiratory Distress is Common

  • Pediatric calls constitute 12-15% of EMS cases, with respiratory distress being the top reason for calls in children under two years old.

• Anatomy Makes Kids Vulnerable

  • Young children have smaller airways, large heads, and obligate nose-breathing, increasing their risk of obstruction.
  • Minor nasal congestion can cause significant breathing issues, so suctioning the nose is often lifesaving.

• Pediatric Assessment Triangle (PAT)

  • Work of Breathing: Look for signs such as retractions, nasal flaring, tracheal tugging, and head bobbing.
  • Mental Status: Lethargy or a lack of responsiveness indicates a worsening condition.
  • Circulation: Cyanosis, poor perfusion, and pallor signal late stages of respiratory failure.
  • PAT allows providers to identify patients at risk of crashing early and intervene before “all three sides of the triangle fail” (referred to as the Triangle of Death).

• Respiratory Distress Progression

  • Retractions progress from intercostal (mild) to severe patterns like head bobbing and sternal rocking, which indicate respiratory failure.
  • Recognize these signs early to prevent hypoxia, bradycardia, and arrest.

• Common Upper Airway Conditions

  • Croup: Most common cause of stridor; responds well to inhaled epinephrine and steroids.
  • Bacterial Tracheitis: Consider if croup-like symptoms persist despite treatments.
  • Epiglottitis: Rare due to vaccinations but still possible; presents with fever, drooling, and tripod positioning.

• Foreign Body Aspiration

  • Common in toddlers (12-24 months); consider aspiration in recurrent respiratory cases.
  • EMS providers should practice airway maneuvers and foreign body removal techniques with tools like Magill forceps.

• Management and Reassessment

  • Intervene early with oxygen, suction, and positive pressure ventilation as needed.
  • Reassess interventions regularly (e.g., after nasal suctioning or oxygen delivery) to ensure improvement or escalate care.

This episode provides practical, actionable guidance for EMS providers to master pediatric airway management and prevent rapid deterioration in respiratory emergencies.

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