Pediatric resp distress

allnurses Guide · Sep 27, 2019

I would assess my patient and intervene based on the assessment. There are a lot of reasons for this to happen, so there is no one answer. What caused it to drop? How far down is it? Is the patient in distress? What meds are they on? Is this a trend? Has it happened before and, if so, is the reason for that known? Does it come back up with intervention? What does the tele monitor say? How do their lungs sound? Is the airway clear? Do you need to call a code? etc etc

Queen Tiye, RN · Sep 27, 2019

Immediate interventions would be to reposition the patient to make sure they are sitting up, properly aligned, and the airway is open. Is the kiddo congested? Still low? How low? Is their a bronchodilator/ breathing treatment prescribed for low sats? Do they need suctioning? Can’t correct the problem quickly, oxygenate and contact provider for persistent desats. Least invasive first. I’m learning too and I’ve been caught not knowing remembering what to do when actually in the moment. Application is a whole other animal compared to just intellectualizing interventions.

PeakRN · Sep 27, 2019

This is very patient and situation specific. Is their pulse ox actually on or laying in the bed? How does the kid look, how is their work of breathing, airway patency, et cetera? How are their other vitals? Does the patient have a ventilatory, respiratory, cardiac output, or other reason for drop in pulse oximetry?

Even if the patient is intubated you don't necessarily need to bag them or increase their FIO2. There may be other interventions that are far more appropriate.

Have you taken NRP, PALS, or ENPC? Did you talk about this with your preceptor?

ICU-BSN · Sep 27, 2019

Always check your patient first. Most of the time a sudden drop is due to one of two things...the pulse ox has come loose/off or the BP cuff is on the same extremity and is cycling. If neither of these is the case, is your patient in obvious distress? Do they need repositioned? Do they need a little supplemental O2, sometimes a couple of L nasal cannula works magic. Maybe they need suctioned. If you can’t determine the cause then by all means ask for help from another nurse or RT.

With a ventilated patient, check the pulse ox, suction, check vent tubing to be sure there’s no disconnection, reposition, maybe vent setting need to be adjusted (know if that is something you can do independently or if you need RT or if it’s physician driven...I’ve found that control of the vent is “owned” by different people at different facilities, know your policy for what you can adjust on your own)

It’s great to think through basic situations like this sometimes Then when they happen in reality you will already have a course of action in mind

mmc51264, BSN, MSN, RN · Sep 27, 2019

No advice, but a child in resp distress is what made me decide that I did not want to work in peds ?

meanmaryjean, DNP, RN · Sep 27, 2019

10 minutes ago, mmc51264 said:
No advice, but a child in resp distress is what made me decide that I did not want to work in peds ?

OK and all but the snacks in Peds are superior to the adult world!

MunoRN, RN · Sep 28, 2019

I wouldn't be so quick to bag them if they're on the vent, unless you're reasonably sure there's a failure with the vent or circuit, taking them of the vent and bagging them is going to do more harm than good.

For a sudden desaturation, make sure your sat reading is correct, and assess your airway, the vent can tell you how much air it's able to move and if there have been changes in it's ability to ventilate, passing the suction catheter down the ETT will allow you make sure the tube is patent (no kinks or occlussions) and also clear out secretions. Positioning of the kid can help as well. If those steps don't work then increase the O2 as needed (or defer that to whomever is allowed to do that) and look at other causes of increased oxygen needs.

murseman24, MSN, CRNA · Oct 1, 2019

On 9/27/2019 at 8:08 PM, MunoRN said:
I wouldn't be so quick to bag them if they're on the vent, unless you're reasonably sure there's a failure with the vent or circuit, taking them of the vent and bagging them is going to do more harm than good.

Why?

PeakRN · Oct 1, 2019

On 9/27/2019 at 6:08 PM, MunoRN said:
I wouldn't be so quick to bag them if they're on the vent, unless you're reasonably sure there's a failure with the vent or circuit, taking them of the vent and bagging them is going to do more harm than good.

12 hours ago, murseman24 said:
Why?

When you break the circuit you lose recruitment. In patients with significant interstitial disease this could cause further deterioration.

It does nothing to address any cause of hypoxia other than a failed or inadequate ventilator. It does nothing to address interstitial disease or for disease of the systemic or pulmonary vasculature. Even if the problem is ventilatory in nature it may be more appropriate to address the patients medications than change the method of ventilation including things like sedation, paralytics, pulmonary hypertension medications, and so on.

It is very presumptuous to think that a person can provide the same or better ventilation than a well functioning ventilator with patient a good ventilatory strategy. No matter how good we think we are we aren't going to match the precision of a modern ventilator. You certainly can't match a Oscillator or jet vent with a bag.

This isn't to say that a home vent, older vent, or a broken vent may need to be disconnected and the patient bagged, but these instances are rare. Much more often there is a different problem, and if you just resort to disconnecting the vent and bagging every time you could be delaying the care the patient actually needs.

brownbook · Oct 1, 2019

Because of this post I had a pediatric nightmare the other night ☹️!

Wuzzie · Oct 1, 2019

2 hours ago, PeakRN said:
When you break the circuit you lose recruitment. In patients with significant interstitial disease this could cause further deterioration.

Also, as a new nurse and sometimes even us oldies get a little ummm excited in these situations and tend to bag too vigorously increasing the risk for some sort of barotrauma. And don't forget those cardiac kids. Their plumbing is all jacked so giving them too much O2 or TV or PIP or PEEP or just looking at them cross-eyed will cause issues. We had a cardiologist who was in the habit of telling nurses "you just killed that baby" if she saw a SaO2 >80 on some of the kids. Yikes!

When I was flying we frequently kept kids on the vent when we were coding them to spare a set of hands. The machines were far more precise than we could ever be.