Interactive Ready for Review: Interactivities

The airway in a child has a smaller diameter than the airway in an adult and is therefore more easily obstructed.

Because the is the principal muscle of respiration in children and infants, gastric distention can create breathing difficulties.

You will need to carry special sizes of airway equipment for pediatric patients.

Use a length-based resuscitation tape to determine the appropriately sized equipment for children.

Use the pediatric assessment triangle (PAT) to obtain a general impression of the infant or child.

In treating possible respiratory failure in a child, always position the airway in a position.

Use an airway adjunct to maintain an open airway: an airway in an unresponsive patient, and a airway in a conscious patient (unless he or she has sustained head trauma).

Appropriate oxygen delivery devices include the blow-by technique at 6 L/min, a nonrebreathing mask at 12 to 15 L/min, and a BVM device at 12 to 15 L/min.

Use a BVM device with a child whose breathing and tidal volume are inadequate and who has an altered level of consciousness. If BVM ventilations are ineffective or if the child will require prolonged ventilatory support, perform intubation.

There are three keys to successful use of the in a child: (1) Have the appropriate equipment in the right size, (2) maintain a good face to mask seal, and (3) ventilate at the appropriate rate and volume: 20 breaths/min for an infant or child, 1 to 11/2 seconds per ventilation. Squeeze gently, and stop squeezing as the chest wall begins to rise; use the phrase "squeeze, release, release" to maintain a proper rhythm.

Children younger than 5 years often obstruct their upper and lower airway with a variety of foreign objects.

If the child is conscious, encourage him or her to cough to clear the airway.

If the child is unresponsive, you should first use the and finger sweeps to try to remove an object that you can see. Never perform blind finger sweeps in infants or children with an airway obstruction.

In treating an unresponsive child with complete airway obstruction, use (in a series of five), alternating with attempts at artificial breathing; in infants, perform back blows and chest thrusts.

In a conscious child who is sitting or standing, apply abdominal thrusts from behind. Continue to perform abdominal thrusts until the obstruction is relieved or the child loses consciousness.

A child who is in early may be breathing too slowly or too fast. Rates greater than 60 breaths/min are a sign of a problem and may require assisted ventilation, especially if tidal volume is reduced (ie, shallow breathing). Look for signs of extra effort to breathe, including and grunting respirations; these may give way to cyanosis--a late sign.

You must intervene immediately if bradycardia develops in a child in respiratory distress. Use the least upsetting method to administer supplemental oxygen, adding assisted ventilations if it becomes necessary. Consider intubation to definitively secure the airway.

Cardiac dysrhythmias, such as V-fib and V-tach, are uncommon in children. When dysrhythmias occur, they usually present as .

Many bradydysrhythmias in children can be successfully treated with ventilatory assistance and 100% oxygen, thereby negating the use of pharmacologic agents.

V-fib and pulseless V-tach are treated with immediate defibrillation and pharmacologic interventions.

Seizures in children may appear as a shaking of the whole body (generalized), a movement in a single arm or leg or eye (partial), or momentary unresponsiveness (absence seizure).

Complications of seizures are due to injury from seizure motion, airway obstruction, or poor breathing effort.

Do not put anything into the mouth of a seizing child. Do position the child so that the tongue is not an obstruction, and be prepared to suction secretions or vomitus.

, occurring on the first day of a fever, may be a sign of a more serious problem such as meningitis. Begin cooling measures and transport the patient to the hospital.