Pediatric emergency medicine trisk 1412 1412
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foreign matter. In the alert patient with suspected soft tissue obstruction of the
airway, a nasopharyngeal airway may improve airway patency. In an unconscious
patient, an oropharyngeal airway can be placed to relieve obstruction. Bag-valvemask ventilation should be initiated in apneic patients or those with ineffective
respiratory efforts. The child in whom airway patency and/or adequate ventilation
and oxygenation cannot be established or maintained using noninvasive
approaches, requires endotracheal intubation. Indications for endotracheal
intubation directly related to respiratory distress include airway obstruction,
inability to handle secretions, and risk of aspiration, and respiratory failure.
Tension pneumo- or hemothorax and/or pericardial fluid causing tamponade must
be decompressed immediately. Ultrasound is increasingly being used in
management of patients in respiratory distress, including to establish lung
pathology, to confirm tracheal intubation, and to guide relevant procedures (e.g.,
thoracentesis, thoracostomy, pericardiocentesis). Adjunctive therapies that can
help with respiratory distress include placement of a nasogastric tube to
decompress a distended abdomen and full expansion of the lungs, addressing
fever, and correcting metabolic derangements and/or drug or toxin intoxication.
