Pediatric Advanced Life Support

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Pediatric Advanced Life Support

• UPPER AIRWAY
• Presented By Mike Pyorala, RCP

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• UPPER AIRWAY
• The portion of the respiratory tract that extends
  from the nostrils or mouth through the larynx.

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• UPPER AIRWAY

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• UPPER AIRWAY

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• UPPER AIRWAY

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• UPPER AIRWAY

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• Airway must be clear and patent for successful
  ventilation.
• Position
• Clear of foreign body
• Free from injury
• .

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UPPER AIR OBSTRUCTION

• UPPER AIRWAY OBSTRUCTION IS A COMMON CAUSE OF
  PEDIATRIC EMERGENCY DEPARTMENT VISITS, ACCOUNTING
  FOR APPROXIMATELY 15 OF ALL CRITICALLY ILL
  PATIENTS
• INFECTIOUS ETIOLOGIES ACCOUNT FOR 90 OF THESE,
  WITH VIRAL CROUP ACCOUNTING FOR 80

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COMMON PEDIACTRIC UPPER AIR OBSTRUCTIONS

• CROUP
• EPIGLOTTITIS

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CROUP

• CROUP AKA LARYNGOTRACHEOBRONCHITIS
• VIRAL
• MOST COMMON CAUSE OF UPPER AIRWAY OBSTRUCTION
• TRANSMITTED VIA RESPIRATORY ROUTE. PORT OF ENTRY
  NOSE NASOPHARYNX

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CROUP

• FIRST FEW DAYS- MILD URI, NASAL CONGESTION,
  COUGH, SORE THROAT
• EDEMA SPREADS AS INFECTION SPREADS
• HOARSE VOICE HARSH BARK LIKE COUGH DEVELOPS
• STRIDOR USUALLY DEVELOPS AT NIGHT

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CROUP

• ELEVATED TEMPERATURE
• MAY HAVE EXPIRATORY WHEEZING
• INSPIRATORY STRIDOR AT REST, NASAL FLARING,
  RETRACTIONS

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CROUP

• TREATMENT
• HUMIDIFIED AIR OR OXYGEN
• STERIODS
• ALBUTEROL
• RACEMIC EPINEPHRINE- MAX EFFECT SEEN IN 30 MIN,
  REBOUND IN 2 HOURS

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EPIGLOTTITIS

• AKA SUPRAGLOTTITIS
• OCCURS IN 3-7 YEARS OF AGE
• BACTERIAL INFECTION- HEMOPHILUS INFLUENZAE
• 1985 VACCINE, BUT VIRUS HAS MUTATED

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EPIGLOTTITIS

• EPIGLOTTITIS, VOCAL CORDS, SUPRAGLOTTIC
  STRUCTURES BECOME INFLAMMED AND EDEMATOUS
• NARROWED AIRWAY
• RESPIRATORY COMPROMISE
• INSPIRATORY AIR OCCLUSION NORMALLY OCCURS PRIOR
  TO TOTAL OCCLUSION

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EPIGLOTTITIS

• MAY ALSO BE CAUSED BY
• HOT LIQUIDS
• FOREIGN BODY INGESTION
• INHALATION INJURIES

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EPIGLOTTITIS

• SYMPTOMS
• VERY SUUDEN ONSET, RAPID PROGRESSON
• MUFFLED VOICE OR CRY
• MINIMAL COUGH
• FEVER
• SORE THROAT
• DROOLING

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REVIEW

• EPIGLOTTITIS
• VOICE- MUFFLED
• COUGH- USUALLY NONE
• FEVER- YES
• SALIVA- LOTS
• NECK SWELLING- LOTS

• CROUP
• VOICE- HOARSE
• COUGH- BARKING
• FEVER- YES
• SALIVA- MINIMAL
• NECK SWELLING- MINIMAL

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REVIEW

• CROUP
• BEGINS- SLOWLY
• SEASON- AUTUMN
• TIME- EVENING / NIGHT

• EPIGLOTTITIS
• BEGINS SUDDENLY
• SEASON- ALL YEAR
• TIME- ALL DAY

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Respiratory Arrest

• Early recognition and intervention prevents
  deterioration to cardiopulmonary arrest and
  probable death.
• Only 10 of children who progress to
  cardiopulmonary arrest are successfully
  resuscitated.

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EPIGLOTTITIS

• SYMPTOMS
• RETRACTIONS
• NOISY, HIGH PITCHED SQUEAKY INHALATIONS
• CYANOSIS
• ODD HEAD POSTURE (SNIFFING POSITION)

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EPIGLOTTITIS

• WHAT CAUSES AIRWAY OBSTRUCTION?

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EPIGLOTTITIS

• WHAT CAUSES AIRWAY OBSTRUCTION?
• FATIGUE
• LARYNGOSPASM
• POOLED SECRETIONS
• PROGRESSIVE SWELLING OF SUPRAGLOTTIC STRUCTURES

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EPIGLOTTITIS

• TREATMENT
• AIRWAY MANAGEMENT
• HIGH FLOW HUMIDIFIED OXYGEN TO MAINTAIN
  SATURATION
• POSITIONOF COMFORT
• NOISY, HIGH PITCHED SQUEAKY INHALATIONS
• CYANOSIS
• ODD HEAD POSTURE (SNIFFING POSITION)
• HOT LIQUIDS
• FOREIGN BODY INGESTION
• INHALATION INJURIES

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REVIEW

• EPIGLOTTITIS
• VOICE- MUFFLED
• COUGH- USUALLY NONE
• FEVER- YES
• SALIVA- LOTS
• NECK SWELLING- LOTS

• CROUP
• VOICE- HOARSE
• COUGH- BARKING
• FEVER- YES
• SALIVA- MINIMAL
• NECK SWELLING- MINIMAL

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REVIEW

• CROUP
• BEGINS- SLOWLY
• SEASON- AUTUMN
• TIME- EVENING / NIGHT

• EPIGLOTTITIS
• BEGINS SUDDENLY
• SEASON- ALL YEAR
• TIME- ALL DAY

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Respiratory Arrest

• Early recognition and intervention prevents
  deterioration to cardiopulmonary arrest and
  probable death.
• Only 10 of children who progress to
  cardiopulmonary arrest are successfully
  resuscitated.

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Pediatric Advanced Life Support
THANK YOU !

• UPPER AIRWAY
• Presented By Mike Pyorala, RCP