Pediatric respiratory care

[MAGICFITZPATRICK]

Who ever CC is... They need to be fired!

[1EMT-P]

I don't know how long your Crew Chief has been practicing, but a paper cup with oxygen tubing IS NOT appropriate for a 4 year old pediatric patient in respiratory distress with an oxygen saturation of 89%. The Blow By Technique Does Not provided high concentrations of oxygen and should only be used if a pediatric patient doesn't tolerate either a nasal cannula or a face mask.

[HarryM]

Also playing devil's advocate....does your system have nebulished brochodilators?

Edited August 5, 2013 by HarryM

[Just Plain Ruff]

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.

MY Goodness finally a RRT that might just stick around. Good to have you here and this forum is DEFINATELY NOT just for EMT's. We have several doctors and nurses here as well as a huge supply of medics and EMT's. You are very much welcome to be a part of this forum as having a pediatric RT who works for a big childrens hospital would be really cool to bounce peds related respiratory problems off of.

I hope you stick around.

Who ever CC is... They need to be fired!

She does not need to be fired, maybe re-trained??? But fired, how the hell do you fire a volunteer?

[dananeal]

I too believe that NRB is a better choice for the infant on the condition of their level of tolerance. I’m very much conscious on the use of paper cup or even some styrofoam cup as they contain dust particles which may worsened a reactive airway or asthma situation.

Edited August 7, 2013 by dananeal

[RuralKSEMS]

Each child is different so I would do what works best for the situation and the pt's needs. My 11 year old daughter is asthmatic, she does okay with somethings on her face and not with others. When she had nasal surgery 2 years ago, she freaked out so bad with the NRB, that they had to take me back to recovery to calm her down. I think we all need to be adaptable to the situation and do what is right at the time of treatment. If a four year old can tolerate a NRB, then use one

[srothig]

Imo I think you did the correct intervention .. if NRB was not tolerated I would of went with canulla and blow by as last resort .. the most important thing was to stop constriction and get SpO2 to come back up above 95 if that was achieved great job ..

I'll wager a bet the CC is the one with all the whacker lights on his vehicle. It is NJ after all. :-}

Hey atleast he got there with the O2 ha

Just curious what was Respiratory rate ?

Edited October 2, 2013 by srothig

[HellsBells]

I'm curious, does your service stock paper cups for this express purpose? I'd be hard pressed to find a paper cup on my ambulance, even if I wanted to make oxygen crafts.