Respiratory Distress in Pediatric Patients.

• The Pediatric Assessment Triangle uses appearance, work of breathing, and circulation to quickly gauge the severity of illness and identify the underlying physiologic disturbance. • Inspiratory stridor generally is a sign of obstruction above the vocal cords, while expiratory stridor is an indication of obstruction in the trachea. Biphasic stridor is an indication of subglottic narrowing, whereas signs of lower airway obstruction include grunting, wheezing, and crackles. • Heated humidified high-flow nasal cannula is studied most commonly as an alternative form of respiratory support where continuous positive airway pressure (CPAP) is indicated. Outside of its role in infants with bronchiolitis, there is relatively limited evidence for heated humidified high-flow nasal cannula therapy in children. • The CPAP apparatus is available as a nasal plug, a nasal mask that covers the nares, a face mask that covers both the nares and the mouth, or a complete face mask that covers the entire face. When CPAP is used, the recommendation is to start low pressures (5 cmH2O) and increase in increments of 1 cmH2O as tolerated by the patient for goals of an exhaled tidal volume > 7 mL/kg, a respiratory rate normal for given age, and oxygen saturation > 90%. • Traditionally, bi-level positive airway pressure (BiPAP) has been used for pediatric patients with neuromuscular disorders, chronic lung disease, and obstructive airways. In the pediatric population, it has been limited to children weighing more than 20 kg because of the concern that small children are incapable of initiating supported breaths while on BiPAP; however, recent studies have shown BiPAP as a beneficial treatment modality for acute severe asthma exacerbations in children of all weights. • New American Academy of Pediatrics guidelines for bronchiolitis do not recommend routine chest radiographs or trials of albuterol or epinephrine aerosols. [ABSTRACT FROM AUTHOR]