RESPIRATORY

DISTRESS AND KGH – Pediatric training

OXYGEN THERAPY
OBJECTIVES
Be able to clearly assess the patient for respiratory distress signs and symptoms

To effectively deliver oxygen therapy to the patient

To continuously monitor the oxygen delivery system and vital signs
 RESPIRATORY DISTRESS
Respiratory distress may be a result of disorders of
 The extrathoracic
 The intrathoracic
 Systemic
Signs and symptoms depend on the age, the causes, and severity, as
well as comorbidities
 RESPIRATORY DISTRESS
Many etiologies
Vascular/cardiac: heart failure
Infectious (viral, bacterial, fungal, parasitic, etc)
Traumatic (RTA, facial burn), toxin (Soda)
Auto-immune (SLE)
Malformations (congenital), metabolic (DKA, renal failure, etc)
Inflammatory like case of burn, anaphylaxis, etc
Neoplastic (leukemia, Lymphoma, etc)
Drug related,
Etc
 INSPECTION OF RESPIRATORY
DISTRESS
Characteristics Features to look for

Abnormal airways Snoring, muffled or hoarse speech, stridor,

sounds grunting, wheezing

Abnormal positioning Sniffing position, tripoding, refusal to lie down

Retractions Supraclavicular, intercostal, subcostal retraction,
chest in-drawing, and head bobbing (nodding)
Flaring Nasal flaring
CNS/ MSK Level of consciousness, cyanosis, sweating
 MANAGEMENT OF
RESPIRATORY DISTRESS
The first priority in evaluating a child with respiratory distress is to
assess the airway, breathing, and circulation (ABCs):
Position the child
Ensure the airways are not obstructed, if yes, clear airways
Assess breathing, adequacy of breathing, and provide oxygen
 Assess the circulatory status and manage accordingly
 Assess other possible causes of respiratory distress and manage
Ensure closer monitoring of therapy and vital signs
OXYGEN THERAPY
 Supplemental oxygen
 Many indications for use, mainly for respiratory distress
 Need adequate monitoring (not too much, not less)
 If change in respiratory patterns change oxygen delivery
amounts (sometimes devices)
 Many devices used to deliver oxygen
OXYGEN DELIVERY DEVICES
DEVICES FOR OXYGEN
DELIVERY
 OXYGEN DELIVERY DEVICES
Device Flow litters/min Oxygen concentration (%)

Nasal prongs 2-4 24-40

Simple facial mask 6-10 35-60

Nonrebreather facial mask 10-15 90-95

Oxygen hood 10-15 80-90

OXYGEN DELIVERY IN
RESPIRATORY DISTRESS
Nasal Prong: mild respiratory
distress
Facial Mask: moderate
respiratory distress
Facial mask with bag: severe
respiratory distress
CPAP: severe respiratory
distress
WHAT TO MONITOR
 Oxygen delivery devices:
functional and working well
Any leakage of oxygen
report it immediately
 Water in humidifier
Quantity of oxygen in cylinder  If the patient improves:
 Anticipate and get the oxygen
source early
Monitor vital signs of patients including
RR, HR, SpO2, and Temperature
If no improvement in respiratory patterns:
Check the whole oxygen delivery system
Increase the amount and/or change the
device (nasal, facial mask, etc)
Continue monitoring of vital signs
Wean progressively off oxygen
Change oxygen delivery devices if
necessary (ex: facial mask  nasal
prong)
 Thank you!!!
Questions and comments
are welcome