Pediatric respiratory care

[island emt]

"In my system we don't use SpO2"

The sign of a company that doesn't want to spend $$ on buying pulse oximetry options on their cardiac monitors.

[iStater]

OK, if you don't want to go by spo2, which we only use as a tool itself plus condition of patient, then the child was obviously in respiratory distress. If the child didn't have a history of asthma I think the op would have stated it was a call for trouble breathing. So. With asthma you will hear the tell tale wheezing, low spo2 levels from inability to exhale and the child will be in the tell tale positioning for trouble breathing.

So oxygen would be a correct drug of treatment

No days with what we all know about using too much O2, I think not having a pulse ox and using it as a tool is irresponsible for any local protocol. As I said, it is too be used as a tool only.

Let's not forget his cc never questioned his use of O2, just his choice of how he administered it.

I apologize for replying to this forum because I know it is for EMTs only. I feel I must comment on this since I do have experience with Peds and work for a large Children's hospital.

You do not always have the tell tale wheezing with asthma. Also, not all that wheezes is asthma. Children can even be in CHF from a cardiac condition. There are also numerous other disease presentations which can wheeze. Children with asthma may also have intrinsic "peep" from the air trapping initially which gives the impression the patient has great SpO2. If the SpO2 is declining then the downside is coming.

In this situation, the oxygen mask was appropriate. Blow by anything is not good except as a very last resort. Blow by nebulizers are a waste but it makes the provider feel like they have done something.

Kids deteriorate fast. Don't split hairs or waste time on a pulse ox reading initially on a child with signs of distress which is hard as hell to get on most children. If the child is still enough to get an accurate reading, that child is probably in serious trouble. Good by other clinical signs and get to an ER preferably at a children's hospital.

Unless you can provide definitive treatment for this child and have the appropriate oxygen device to meet his needs including ventilator demand, go with what works now to give him some relief. Even a nonrebreather mask is no match for high flow devices which can meet the demands with a fairly consistent FiO2. You might think a nonrebreather mask is giving 100% but for a patient with a high demand from distress that is not true.

[paramedicmike]

I apologize for replying to this forum because I know it is for EMTs only.

This forum is not for EMTs only. There are a wide variety of providers who participate here. Yes, our focus in prehospital medicine. That does not mean, however, that we're limited to just EMTs.

Just a general FYI.

Thanks for your comments. They are certainly appropriate and instructive if people want to take your information and follow up with their own reading.

[BushyFromOz]

We all like making cool things like o2 tube in paper cups when kiddies get scared of masks, but if they are happy to use it then they are happy to use it. I dont get what your crew chiefs issue is.

[DwayneEMTP]

iStater, your post was great..I wish that you'd post more often!

We, when we're not off in the ditch, are about learning and trying to apply that learning, you're a perfect fit. Maybe you've noticed, at least rumor has it, that there might be one or two other RN/RRTs here...

Welcome..I hope that you'll stick around...but, be gentle, remember, a bunch of us are only goofy paramedics.. :-)

[MariB]

/> I apologize for replying to this forum because I know it is for EMTs only. I feel I must comment on this since I do have experience with Peds and work for a large Children's hospital.

You do not always have the tell tale wheezing with asthma. Also, not all that wheezes is asthma. Children can even be in CHF from a cardiac condition. There are also numerous other disease presentations which can wheeze. Children with asthma may also have intrinsic "peep" from the air trapping initially which gives the impression the patient has great SpO2. If the SpO2 is declining then the downside is coming.

In this situation, the oxygen mask was appropriate. Blow by anything is not good except as a very last resort. Blow by nebulizers are a waste but it makes the provider feel like they have done something.

Kids deteriorate fast. Don't split hairs or waste time on a pulse ox reading initially on a child with signs of distress which is hard as hell to get on most children. If the child is still enough to get an accurate reading, that child is probably in serious trouble. Good by other clinical signs and get to an ER preferably at a children's hospital.

Unless you can provide definitive treatment for this child and have the appropriate oxygen device to meet his needs including ventilator demand, go with what works now to give him some relief. Even a nonrebreather mask is no match for high flow devices which can meet the demands with a fairly consistent FiO2. You might think a nonrebreather mask is giving 100% but for a patient with a high demand from distress that is not true.

please post more!

Do not feel this site is for just EMTs it is for all of us to bounce ideas off etc.

Yes I know other conditions can cause wheezing and I know not all asthma attacks will not have a wheeze. However most do when auscilated and Mike EMT was questioning op as to why he was sure it was asthma.

[MikeEMT]

iStater hit it on the head. The point I was trying to make is a NRB isn't the automatic best choice in every situation. I was hoping that the OP would come back and reply to my original post with the reason why he chose an NRB. I would like to see that the OP knew why he was providing the treatment rather than "the book says too". One of the most important things you need to do as a provider at ANY level is to justify your interventions. Being someone who wasn't at this call and knowing it was a peds with hx of asthma why did the NRB come out? Were there other signs and symptoms related to respiratory distress?

I question the Pulse Ox reading, especially on a child. The pulse ox is very sensitive to dirt and grime on the patients fingers. Did you check the cleanliness of the fingertips? Was the child still? If they are in true respiratory distress they wont be sitting still, if they are that is REAL BAD. Did you consider other conditions responsible for the breathing problems?

BTW thank you MariB, you seem to be the only one that actually read my post and got my point.

"In my system we don't use SpO2"

The sign of a company that doesn't want to spend $$ on buying pulse oximetry options on their cardiac monitors.

Just so you know our cardiac monitors have SpO2. We just don't carry them BLS. Neither do the fire departments around here but this is a discussion for another thread.

[ERDoc]

If they are in true respiratory distress they wont be sitting still, if they are that is REAL BAD. Did you consider other conditions responsible for the breathing problems?

I disagree with this. I have seen plenty of kids who were in distress just sit there without circling the drain. Sometimes they just feel so crappy that they don't want to move and feel better cuddling with a parent.

[iStater]

I disagree with this. I have seen plenty of kids who were in distress just sit there without circling the drain. Sometimes they just feel so crappy that they don't want to move and feel better cuddling with a parent.

I guess that depends on the degree of distress and how long you want to wait for them to circle the drain. The words kids and distress should just not happen in the same sentence but when it does, I believe we should try to prevent a child from suffering for very long if it is at all possible. I guess that is why some of us do specialize in working with children.

Another thing is to be very careful with the paper cup or even some styrofoam cups. They can contain dust particles which may worsened a reactive airway or asthma situation.

[ERDoc]

I guess that depends on the degree of distress and how long you want to wait for them to circle the drain. The words kids and distress should just not happen in the same sentence but when it does, I believe we should try to prevent a child from suffering for very long if it is at all possible. I guess that is why some of us do specialize in working with children.

Agreed, I was just saying that just because a kid is still does not mean he/she is circling the drain. When kids don't feel good, especially younger ones, they will get like this. Can it mean something bad? Absolutely. I work in a peds ER so I am well aware of people who specialize in kids.