Respiratory distress of young children: how to react?

It is essential to quickly identify, assess and manage respiratory distress of the child, said Dr. Christine Vitoux-Brot, Robert Debré Hospital (Paris, 19th), at the seminar of the French Society of Emergency Medicine (SFMU), which was held in Clermont-Ferrand on the subject of acute respiratory distress emergency

Types and signs

Respiratory distress of children account for 14% to 25% of the reasons for consultation with pediatric emergencies and are the most common cause of cardiac arrest in young children, said Dr. Vitoux-Brot's summary.

Respiratory rate of young children varies from 50 per minute in the neonatal period to 12 per minute in adolescence. The respiratory rate is also an important element of evaluation, the doctor says: irregular with pauses, it reflects the exhaustion of the child, respiratory arrest may be imminent, she warned.

Signs of struggle associated with the use of accessory muscles and flaring nose sign of airway obstruction. Cyanosis is a late sign often resulting impending acute respiratory failure and need for immediate therapeutic measures, she noted. Early detection of hypoxemia by the systematic measurement of transcutaneous saturation is a necessary element of evaluation: a saturation less than 90% is a sign of seriousness.

To identify the mechanism, the interrogation must specify the mode of onset of dyspnea, neonatal history, respiratory, neurological and heart, as well as the quality of food intake. Clinical analysis precise time of dyspnea, which can guide the etiology.

The causes of violations of the upper airway can be infectious (obstructive rhinitis very young infant, acute laryngitis, epiglottitis, pharyngeal abscess or peri-tonsillar), the result of birth defects, or secondary beings with laryngeal edema allergic .

With respect to the lower airways, they can be linked to bronchiolitis, asthma, infectious pneumonia, inhalation of foreign bodies but also to the young infant heart failure or acute anemia and some metabolic abnormalities .

Maintain proper oxygenation

"Before any dyspnea child, the first objective is to ensure proper oxygenation," says Dr. Vitoux-Brot.

"The insertion of an intravenous line is systematic when respiratory distress is severe or that parenteral drugs are needed, otherwise we may not need to attack the child," she says. Intubation by a trained physician, is required when the prognosis is engaged.

"Other acts of rescue may be required: pleura, exsufflation pneumothorax, maneuver removal of foreign body, tracheotomy," says Dr. Christine Vitoux-Brot. If inhaled foreign body with complete obstruction, a rescue operation "should be attempted in cases of asphyxia." In case of failure, the prognosis is quickly engaged and laryngoscopy is necessary to try to remove the foreign body with forceps Magill, she says, adding that "any patient suspected of inhalation foreign body must have an endoscopy in hospital. "