Pediatric Respiratory Emergencies
Respiratory failure is the leading cause of pediatric cardiac arrest. On the NREMT, a pediatric respiratory question is really an early-intervention question: recognize distress before it becomes failure.
EMT · AEMT · Paramedic
Distress vs failure vs arrest
The Pediatric Assessment Triangle (appearance, work of breathing, circulation) drives the decision. Grunting, head bobbing, and tripoding are late signs — treat them as pre-arrest.
- Distress: tachypnea, retractions, nasal flaring, still alert
- Failure: bradypnea, decreased tone, cyanosis, altered LOC
- Arrest: apnea or agonal, no perfusing rhythm — start CPR
Upper airway: croup vs epiglottitis
Croup is viral, barky cough, slow onset, kids look okay — humidified O₂, nebulized epinephrine per protocol. Epiglottitis is a bacterial emergency: drooling, tripod, muffled voice, toxic-appearing. Keep them calm, do NOT inspect the airway, transport upright with parent.
Lower airway: asthma and bronchiolitis
Asthma: albuterol ± ipratropium, IM epi 0.01 mg/kg for severe. Bronchiolitis (RSV in infants < 2): mostly supportive — suction, oxygen, position — bronchodilators are hit-or-miss.
Foreign body airway obstruction
Effective cough → encourage, transport. Ineffective cough with responsive infant: 5 back blows / 5 chest thrusts. Child: abdominal thrusts. Unresponsive: CPR, look before each ventilation, remove only if you see it.
Frequently asked
- When do I give epi for pediatric respiratory distress?
- IM epi 0.01 mg/kg (1:1,000) for anaphylaxis or severe asthma unresponsive to albuterol. Nebulized epi is used for severe croup.
- Should I attempt to visualize the airway in suspected epiglottitis?
- No. Any agitation can precipitate complete obstruction. Keep the child calm, provide blow-by O₂, and transport with a parent.
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