PALS | Management of Pedi Resp. Arrest Extended

80/20 Summary: Pediatric Respiratory Emergency Management

Respiratory failure causes most pediatric cardiac arrests[1]. Prompt management via the Evaluate-Identify-Intervene cycle restores oxygenation and ventilation before collapse[1][2].

1. Core Life-Support & Initial Management

• Rescue Breathing: For respiratory arrest with a pulse, give 12–20 breaths/min (1 breath every 3–5 seconds), each over 1 second for visible chest rise[2]. Reassess pulse every 2 minutes[2].
• Airway Management: Position in comfort or perform head tilt-chin lift (jaw thrust if trauma suspected)[3]. Suction secretions; insert an OPA only if unresponsive without a gag reflex, or an NPA if a gag is present (avoid NPA in facial trauma)[3][4].
• Breathing & Circulation: Provide high-flow O2 via nonrebreathing mask; assist bag-mask ventilation (BMV) if needed[3]. Monitor SpO2, HR, BP, and establish IV/IO access[3].

2. Targeted Management by Etiology Category

Upper Airway Obstruction

• Croup: Mild cases get dexamethasone[5]. Moderate-to-severe require humidified O2, nebulized epinephrine, and dexamethasone[5]. Impending failure needs high-flow O2, BMV, dexamethasone, and ET intubation with a tube 0.5 size smaller[5].
• Anaphylaxis: Give IM epinephrine q10–15 min[6]. Give IV methylprednisolone, albuterol, antihistamines, and 20 mL/kg IV fluid boluses for hypotension[6].
• FBAO: Infants (<1 yr) get 5 back slaps + 5 chest thrusts; children (≥1 yr) get abdominal thrusts[7]. If unresponsive, start CPR; inspect mouth before breaths (no blind finger sweeps)[7].

Lower Airway Obstruction

• Hyperventilation Risks: Avoid hyperventilation during BMV to prevent gastric distension, pneumothorax, and severe air trapping[8].
• Bronchiolitis: Suctioning; bronchodilator trial; O2 for SpO2 < 94%[8].
• Acute Asthma: Give O2, albuterol, and steroids[9]. Severe cases get continuous albuterol, ipratropium, IV steroids, and IV magnesium sulfate[9].

Lung Tissue Disease

• Pneumonia: Give antibiotics within 1 hour, albuterol for wheezing, and CPAP/NIV[10].
• Cardiogenic Edema: Support with PEEP, diuretics, and inotropes[11].
• ARDS: Use permissive hypercapnia, low tidal volume (5–8 mL/kg), and PEEP[12]. Avoid succinylcholine in neuromuscular disease[13].

Disordered Control of Breathing

• Increased ICP: Head midline, avoid hyperventilation (PaCO2 < 30 mmHg causes vasoconstriction), give hypertonic saline/mannitol[14].
• Poisoning: Contact Poison Control, maintain airway, give antidotes (naloxone)[13].

3. Key Takeaways

1. Stabilize ABCs First: Restore oxygenation before advanced therapy[2][3].
2. Select Right Adjunct: OPA for no gag; NPA for intact gag[4].
3. Avoid Over-Ventilation: Prevents barotrauma and reduced cardiac output[8].