Part_3__Management__Special_Paediatric_Considerations_and_Disposition_slides_ 3.pdf

Difficulty in breathing and management and paediatric considerations

1. Difficulty in Breathing
Part 3: Management, Special PaediatricConsiderations and
Disposition
This learning content has been developed in collaboration with the WHO Academy.

2. Objectives
By the end of this presentation, you will be able to:
•Describe critical actions to manage patients with difficulty in breathing
•Identify essential skills for high-risk causes of difficulty in breathing
•Describe special paediatric considerations for difficulty in breathing
•Consider the disposition and transport of patients with difficulty in
breathing

3. Management
If suspected airway inflammation or burns
→Keep patient calm.
→Give OXYGEN, avoid distress.
→If patient is alert without other injuries, the seated
position may be more comfortable.
→Consider early advanced airway management
•Airway can swell and block quickly; delays may make
intubation more difficult.
→Plan for rapid HANDOVER/TRANSFER.
©WHO/Laerdal Medical

4. Management
If suspected choking
→Use age-appropriate chest thrusts/abdominal thrusts/back blows.
©WHO/Laerdal Medical
©WHO/Laerdal Medical ©WHO/Laerdal Medical
BACK BLOWS ABDOMINAL THRUSTS CHEST THRUSTS IF PREGNANT

5. Management
If suspected choking in infants
→Alternate between 5 back
blowsand 5 chest thrusts.
©WHO/Laerdal Medical
BACK BLOWS
CHEST THRUSTS

6. Management
If suspected allergic reaction
→Remove allergen.
For severe allergic reaction with difficulty breathing:
→Give intramuscular ADRENALINE without delay.
→Give OXYGEN.
If suspected asthma/COPD
→Give SALBUTAMOL.
→Give OXYGEN if indicated.
If suspected difficulty in breathing and fever
→Give ANTIBIOTICS as soon as possible.
→If signs of poor perfusion, give IV FLUIDS.
©WHO/Laerdal Medical
SALBUTAMOL
VIASPACER

7. Management
If suspected heart attack
→Give ASPIRIN
→Give OXYGEN with symptoms of shock or difficulty
breathing.
→If patient has NITROGLYCERIN, assist them in taking it.
If suspected chronic, severe anaemia
→Give IV FLUIDS slowly.
→Listenfrequentlyfor crackles in the lungs (fluid
overload)
→Prepare for handover/transfer for possible BLOOD
TRANSFUSION.
If suspected diabetic ketoacidosis (DKA)
→Give IV FLUIDS.
→Prepare for urgent transfer.
©WHO/Laerdal Medical

8. Management
If suspected opioid overdose
→Support breathing with a BAG-VALVE-MASK as needed.
→Give NALOXONE.
If suspected large pleural effusion or haemothorax
→Give OXYGEN.
→Arrange for urgent HANDOVER/TRANSFER.
→Patient requires CHEST TUBE or drain.
©WHO/Laerdal Medical

9. Management
If suspected trauma
→Give OXYGEN.
→If tension pneumothoraxis suspected, perform NEEDLE DECOMPRESSION
as soon as possible
•Prepare for rapid transfer for chest tube insertion.
→If tension pneumothorax or cardiac tamponade, give IV FLUIDS.
→Treat sucking chest woundswith a 3-sided occlusive dressing.
•Prepare for rapid transfer for chest tube insertion.
THREE-SIDED
DRESSING
©WHO/Laerdal Medical

10. Management
If suspected acute chest syndrome (sickle cell patients)
→Give OXYGEN.
→Give IV FLUIDS.
→May need HANDOVER/TRANSFER
©WHO/Laerdal Medical
©WHO/Laerdal Medical

11. Special PaediatricConsiderations:Danger Signs
•Signs of airway obstruction (unable to swallow, drooling, stridor)
•Increased breathing effort
•Cyanosis
•Altered mental status
•Poor feeding
•Vomiting everything
•Seizures/Convulsions
•Low body temperature
!

12. Special PaediatricConsiderations:
•Wheezing in children can be a viral infection or a foreign object.
•Stridor can be caused by airway swelling or a foreign object.
•Rapid breathing may be the only sign of pneumonia.
•Rapid breathing can indicate diabetic ketoacidosis (DKA) as the first sign
of diabetes in children.
!

13. Disposition of the Patient
Ongoing Monitoring
•Inhaled medications such as salbutamol only last approximately 3
hours.
•A severe allergic reaction can return when adrenaline wears off.
•Naloxone only lasts about 1 hourand may require repeat doses.
•Most opioid medications last longer than this.
•Following submersion injuries, a person may develop breathing
problems later.
Remember these patients need to be monitored closely!

14. Transport Considerations
•Never leave a patient who might need
definitive airway placement unmonitored
during handover/transfer.
•Make transfer arrangements as early as
possible for any patient who may require
assisted ventilation.
©WHO/Laerdal Medical
An Unmonitored Airway Can Easily
Obstruct!

15. Remember
•PerformABCDEs first
•Treatlife-threatening conditions
•Takea SAMPLE history
•Doan extended physical examination
•Thinkabout causes
•Thinkabout considerations in children
•Thinkabout disposition and transport

16. Summary
In this presentation, we have covered:
•Critical actions to manage patients with DIB
•Essentialskills for high-risk causes of difficulty in breathing
•Special paediatric considerations for DIB
•Disposition and transport of patients with DIB