Respiratory Distress Pediatric Bronchiolitis  

Patient Care Goals

Promptly identify pediatric respiratory distress, failure, and/or arrest, and intervene for patients who require escalation of therapy. Deliver appropriate therapy by differentiating other causes of pediatric respiratory distress.

Assessment

Pediatric Pearls:	Signs & Symptoms:	Differential:
□ Nasal suctioning can rapidly improve distress □ Assess hydration status □ Identify signs of severe respiratory distress	□ Child < 2yo □ Rhinorrhea □ Cough □ Fever □ Tachypnea or other signs of respiratory distress □ Coarse breath sounds	□ Asthma □ Foreign body aspiration □ Pneumonia □ GERD □ Croup □ Pertussis • Epiglottitis

Clinical Management Options

EMT-B

• Place in position of comfort • Oxygen target SpO2 92% – 96%   • Suction the nose and/or mouth (via wall mount or portable suction) • Basic airway management as needed • Consider ALS intercept for any evidence of worsening or severe respiratory distress

Paramedic

• Monitor ETCO2 if the patient tolerates it • Consider IV for signs of hypovolemia • Provide Inhaled Epinephrine for severe respiratory distress that is not improved with suctioning and/or oxygen  • Cardiac Arrest Epinephrine: Nebulize 5 mL of 0.1 mg/mL (0.5 mg)  • Intramuscular Epinephrine: concentration: 1:1,000 dose: 0.15mg (0.30mg if >25kg) • Consider advanced airway options

Signs of Respiratory Failure-Separate checklist under pearls please

• Change in mental status such as fatigue and listlessness  • Pallor  • Dusky appearance  • Decreased retractions  • Decreased or irregular respiratory rate

Pearls

• Bronchiolitis is a common lung infection in young individuals
• Symptoms worsen over the course of 2-3 days after the onset of a viral syndrome 
• This is a clinical diagnosis and labs or imaging are rarely indicated
• Bronchiolitis is a mild, self-limited infection of the lower respiratory tract in the majority of children but may sometimes progress to respiratory failure in infants.
• Suctioning can be a very effective intervention to alleviate distress, since infants are obligate nose breathers
• Albuterol is not generally indicated or beneficial in the treatment of bronchiolitis but may be trialed if wheezing is present or has been effective in the past
• Nebulized saline, Ipratropium and other anticholinergic agents should not be given to children with bronchiolitis in the prehospital setting
• Improvement of oxygenation and/or respiratory distress should be achieved with the least invasive method possible at all times
• BVM is the preferred airway management option in children. Consider I-gel in patients that cannot be ventilated with BVM
• About 3% of infants will require admission to the hospital, and the mortality rates vary from 0.5% to 7% in high risk patients
• The management of bronchiolitis is supportive with suctioning, hydration and oxygen. No specific medications treat the infection.