5. PEDIATRIC EMERGENCIES
5.4 PEDIATRIC BRONCHOSPASM
Bronchospasm is defined as spasmodic narrowing (contraction) of the lumen (bronchial muscle) of a bronchus for whatever reason resulting in restricted airflow. This results in hypoventilation of the alveoli leading to hypoxemia. The causes of acute bronchospasm may not always be easily discernible. Wheezing in children can occur from a variety of causes. Patients with asthma can wheeze in response to weather changes, stress, exercise, infection or allergy. Pneumonia, bronchitis and bronchiolitis are some of the infectious causes of wheezing. Other causes of pediatric wheezing include foreign bodies (tracheal, bronchial and esophageal) and congenital abnormalities of mediastinal structures, including the heart, trachea and larynx. Unless cardiac problems are suspected, wheezing is treated with bronchodilating agents. Concurrent hypotension should raise concern regarding anaphylaxis or respiratory failure. If the patient has evidence of drooling, hoarseness or stridor, follow Pediatric Upper Airway Obstruction protocol.
Mild distress in children is evidenced by minor wheezing and good air entry.
Severe distress in children is evidenced by poor air entry, extreme use of accessory muscles, nasal flaring, grunting, cyanosis and/or altered mental status (weak cry, somnolence, poor responsiveness). REMEMBER: Severe bronchospasm may present without wheezes indicating minimal air movement.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain open airway, remove secretions or vomitus, and assist ventilation as needed. Determine presence of upper airway involvement (stridor) or lower airway symptoms (wheezing). These may coexist.
3. Administer high concentration of oxygen by non-rebreather mask.
4. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and vital signs. Evaluate capillary refill and determine if blood pressure is appropriate for age. (SEE APPENDIX)
5. Obtain appropriate history related to event, including Past Medical History (prior asthma, anaphylaxis, allergies), Medications, Drug Allergies and Substance Abuse. NOTE: exposures to foreign body, (new) foods, medicines, chemicals or envenomation.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway management, suctioning or use of airway adjuncts as indicated.
3. Administer high concentration of oxygen by non-rebreather mask. (humidified O2 is acceptable)
4. Activate ALS intercept, if deemed necessary and if available.
5. Initiate transport as soon as possible with or without ALS.
6. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway management, suctioning or use of airway adjuncts as indicated.
3. Administer high concentration of oxygen by non-rebreather mask. (humidified O2 is acceptable)
4. Activate Paramedic intercept, if deemed necessary and if available.
5. ALS STANDING ORDERS
a. Provide advanced airway management if indicated.
b. Consider IV Normal Saline (while enroute) if in severe distress.
6. Initiate Transport as soon as possible with or with out Paramedics.
7. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway management, suctioning or use of airway adjuncts as indicated.
3. Administer high concentration of oxygen by non-rebreather mask. (humidified O2 is acceptable)
4. Cardiac monitoring / dysrhythmia recognition: manage per protocol.
5. ALS STANDING ORDERS
a. If the pediatric patient's condition is not improving with administration of supplemental oxygen, consider the following:
- Albuterol Sulfate 0.5%: 0.25 ml, if less than 2 years of age via nebulizer.
- Albuterol Sulfate 0.5%: 0.5 ml, if age 2 years or greater via nebulizer.
b. Consider Saline lock or IV Normal Saline if in severe distress.
c. For severe distress: Epinephrine 1:1,000, 0.01 mg/kg subcutaneously (maximum single dose 0.3 mg).
6. Initiate transport as soon as possible.
7. Contact MEDICAL CONTROL. The following may be ordered:
a. Albuterol Sulfate 0.5% (repeat dosages as identified above) via nebulizer.
b. Epinephrine 1:1,000, 0.01 mg/kg subcutaneously (maximum single dose 0.3 mg).
c. If the pediatric patient's respiratory status worsens: go to Pediatric Anaphylaxis Protocol.
8. Notify receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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