Emergency medical care: o Administer O2 (humidified = preferred) to maintain SpO2 ≥ 94% o Keep patient in position of comfort (propped up/in caregiver’s arms) o Transport patient to hospital w as little disturbance as possible o Cool night air can reduce swelling in airway (relief) Epiglottitis Caused by bacterial infection that inflames/causes swelling of epiglottis; life-threatening (50% mortality rate if left untreated) Onset usually rapid; accompanied by high fever More commonly seen in young adults than children since introduction of Hib vaccine o Exception = areas where immunizations not common/different agents causing disease Signs/symptoms: o Pain on swallowing; drooling o High fever (102°F- 104°F) and “toxic” ill-appearing child o Mouth breathing; inspiratory stridor; respiratory distress o Changes in voice quality/pain upon speaking o Tripod position; chin and neck thrust outward o Strikingly still appearance as attack worsens Emergency medical care: o Do not place anything in child’s mouth unless completely unresponsive/not moving any air o Allow child to assume position of comfort (usually sitting upright, leaning forward) o Provide O2 at 15lpm via NRB Provide blow-by oxygen if child doesn’t tolerate mask Be careful it doesn’t cause irritation/coughing If airway completely obstructed, provide BVM ventilations w supplemental O2
o Consider ALS backup if it doesn’t delay transport (ET intubation/surgical airway) o Transport Asthma Long-term inflammatory process that targets lower airways; inflammation characterized by increased production of mucus and acute narrowing of airways through inflammation/swelling Narrowing of airway increases resistance in bronchioles (produces wheezing) Common symptoms: o Shortness of breath o Chest tightness; non-productive, “tight” coughing o Wheezing Get patient’s history, including: o Duration of wheezing; fluid intake during this period o Recent cold/infection; any known allergies o Medications taken for this attack (what/how much/when) Secondary assessment: pay close attention to following: o Position Mild attacks- often appear agitated and prefer to sit but will lie still Severe attacks- seem exhausted/unable to move; prefer tripod position Children < 2 often show no agitation/lie on their backs o Mental status: sleepiness/changes in mental status = progressively more serious signs of hypoxia, acidosis, and retention of CO2 o Vital signs: Pulse grows faster and weaker as attack worsens; BP can fall Bradycardia = ominous sign of impending respiratory/potential cardiac arrest o Skin color/conditions: Usually have some degree of dehydration from poor oral intake, severe coughing that might stimulate vomiting, and increased insensible losses from rapid RR Check for cyanosis of tongue/mucous membranes o Respirations: Mild-moderate attack- loud breathing sounds, loud wheezes, occasional crackles
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- Fall '19
- Paul Palmiotto