INITIAL MANAGEMENT OF RESPIRATORY DISTRESS/FAILURE
AIRWAY
Open and support the airway
Suction
Consider advanced airway
BREATHING
Monitor O2 sats
Supplemental O2
Nebulizers
CIRCULATION
Monitor vitals
Establish vascular access
Table 13
As an example, croup management depends on the severity of the disease.
Dexamethasone, a corticosteroid, can cause hypertension and reduce activation of lymphocytes.No carotid artery pulse detected.
PALS management of respiratory distress/failure is adjusted based on the severity of the current condition. For example, mild asthma is treated with bronchodilator inhalers, but severe asthma (status asthmaticus) may require ET intubation. The provider must continually assess the person’s current needs and adjust care accordingly.
Croup Management
Figure 12
UPPER AIRWAY
LOWER AIRWAY
CAUSE
TREATMENT
CAUSE
TREATMENT
CROUP
Dexamethasone
Oxygen (Heliox)
Nebulizer (epinephrine)
Intubate
Tracheostomy
BRONCHIOLITIS
Suctioning
Nebulizers
FOREIGN BODY
Dexamethasone
Oxygen (Heliox)
Nebulizer (epinephrine)
Intubate
Tracheostomy
ASTHMA
Oxygen (Heliox)
Nebulizers (albuterol and ipratropium bromide)
Corticosteroids
Magnesium sulfate
Epinephrine SQ
Support breathing
ANAPHYLAXIS
Epinephrine IM
Nebulizer
Diphenhydramine
LUNG TISSUE DISEASE
CNS ISSUES
CAUSE
TREATMENT
CAUSE
TREATMENT
PNEUMONIA
Dexamethasone
Oxygen (Heliox)
Nebulizer (epinephrine)
Intubate
Antibiotics (bacterial)
Tracheostomy
OVERDOSE
Naloxone (opioid reversal)
Antidotes
Support breathing
PNEUMONITIS
Nebulizers
Support breathing
TRAUMA
Neurosurgery
Reduce intracranial pressure
Support breathing
PULMONARY EDEMA
Diuretics
Inotrope
Support breathing
Table 14
In general, providers commonly work from the least to the most invasive intervention (top to bottom).
If the person presents with severe distress, proceed directly to maneuvers that are more aggressive.
Albuterol is the most common medication used via nebulizer to cause bronchodilation.
Common causes of acute community-acquired pneumonia include Streptococcus pneumonia, Mycoplasma pneumonia, Haemophilus influenza, and Chlamydia pneumonia.
High fever is the most common cause of quiet tachypnea.