Pediatric emergency medicine trisk 1398 1398
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in sludging of blood and therefore compromised O2 delivery (see Chapter 93
Hematologic Emergencies ).
EVALUATION AND DECISION
Triage and Stabilization
Every child with significant respiratory distress must be considered to be at
potential risk of progressing to respiratory arrest. Airway patency, breathing, and
circulation should be rapidly assessed and, if compromised, should be supported
immediately before further evaluation ( Table 71.6 ). Respiratory arrest can
rapidly evolve into cardiac arrest if resuscitative interventions are not timely.
Cardiorespiratory status should be continuously monitored. A healthcare
provider skilled in airway management and resuscitation should remain with the
patient at all times. Stepwise and focused evaluation is critical for determining the
source and severity of respiratory distress. In the child who is alert and otherwise
healthy, the position that he or she has naturally assumed is likely to be the one
that minimizes respiratory distress and thus should be maintained. A child with
significant respiratory distress should be allowed to remain with the parents and
should not be agitated. Agitation and crying increase minute ventilation and add
significantly to the child’s O2 consumption. Fever increases metabolic demand
for oxygen. Any patient with ventilatory compromise should be treated
immediately with supplementary O2 . In patients with decreased sensorium or
neuromuscular disease, a position to optimize airway patency must be
established. Airway devices or assisted ventilation may be necessary. For
management of cardiorespiratory arrest, resuscitation efforts must be initiated
immediately, as detailed in Chapters 7 A General Approach to the Ill or Injured
Child and 8 Airway .
History
A detailed history usually provides important clues to the cause of respiratory
distress, but in a critically ill or injured child, comprehensive details should not be
obtained at the expense of expedient patient care. A brief history can be obtained
while emergent treatment is initiated. Details can follow once the child is
stabilized. Information obtained by history should include a description of
respiratory and other symptoms, onset and duration of symptoms, possible
precipitating factors including ill contacts, environmental exposures and recent
travel, trauma, therapeutic interventions, history of previous similar symptoms,
underlying medical conditions, particularly those that predispose to respiratory
