pRRAPID

B

Breathing

BREATHING - INTRODUCTION

Breathing problems are a common cause for deterioration in children. It is vital to be able to assess, diagnose and manage immediately life-threatening problems and to be able to identify those patients who are at risk of developing respiratory failure during their hospital stay. This is especially important as, in children, cardio-respiratory arrest is commonly secondary to hypoxia.

 

A

Recognition

Effort of breathing:

  • Respiratory rate
  • Recessions
  • Accessory muscle use
  • Flaring of nostrils
  • Inspiratory and expiratory noises: wheeze, stridor, and crepitations?
  • Grunting
  • Posture/position

Efficacy of breathing

  • Equal air entry?
  • Percussion note
  • Trachea central?
  • Gasping?
  • SpO2 in air
  • Chest movement

Effect on body:

  • Heart rate
  • Capillary refill
  • Conscious level

Response

  • If not breathing- ventilate with a bag-valve mask (BVM) device
  • Give O2 15 L/min via a non-rebreathe mask with reservoir bag
  • Aim O2 saturations 94-98%
  • Blood gas (ABG) – usually performed venously or capillary in infants and small children
  • Chest X-ray (CXR)
  • Site a nasogastric tube (especially if using a BVM)

Table: Breathing Recognition and Response