Regional Emergency Medical Advisory Committee of New York City
Prehospital Basic Life Support Protocols
Copyright January 1996 (8/96)

450 PEDIATRIC RESPIRATORY DISTRESS/FAILURE

NOTE:RESPIRATORY DISTRESS IN A CHILD IS CHARACTERIZED BY INCREASED RESPIRATORY EFFORT WITHOUT CENTRAL CYANOSIS, I.E., ANXIETY, TACHYPNEA, NASAL FLARING, AND INTERCOSTAL RETRACTION.

RESPIRATORY FAILURE IN A CHILD IS CHARACTERIZED BY INEFFECTIVE RESPIRATORY EFFORT WITH CENTRAL CYANOSIS, I.E., AGITATION OR LETHARGY, SEVERE DYSPNEA OR LABORED BREATHING, BOBBING OR GRUNTING, AND MARKED INTERCOSTAL AND PARASTERNAL RETRACTIONS.

BRADYCARDIA IS AN OMINOUS SIGN THAT INDICATES HYPOXIC CARDIAC ARREST MAY BE IMMINENT.

Monitor the airway.

If an obstructed airway is suspected, see Protocol #451.

If croup or epiglottitis is suspected, see Protocol #452.

IF RESPIRATORY DISTRESS IS PRESENT:

Administer oxygen and allow patient to maintain a comfortable, upright position.

NOTE:HIGH CONCENTRATION OXYGEN SHOULD ALWAYS BE USED IN PEDIATRIC PATIENTS. DO NOT ALLOW THE MASK TO PRESS AGAINST THE EYES.

IF RESPIRATORY FAILURE IS PRESENT:

Assist ventilations at a rate of 20 breaths per minute.

NOTE: DO NOT USE A DEMAND VALVE RESUSCITATOR DUE TO THE POSSIBILITY OF CAUSING SEVERE LIFE THREATENING COMPLICATIONS.

NOTE:CHEST RISE IS THE BEST INDICATION OF ADEQUATE VENTILATION IN THE PEDIATRIC PATIENT.

Request Advanced Life Support assistance.

Monitor breathing for adequacy.

Transport, keeping the child warm.

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