Respiratory and Cardiovascular Care
Core concepts
Respiratory assessment: rate, effort (retractions, nasal flaring, grunting), oxygenation (SpO2), breath sounds, and mental status. Recognize upper airway obstruction (stridor, drooling, tripod positioning-do not examine the throat), lower airway disease (wheezing, prolonged expiration), and pneumonia (fever, crackles). Oxygen delivery devices range from nasal cannula to nonrebreather; humidification and appropriate flow matter.
Asthma management: assess severity, give bronchodilators and corticosteroids per protocol, and teach inhaler/spacer technique and action plans. For bronchiolitis, supportive care predominates-hydration, suctioning, oxygen; avoid unnecessary interventions.
Cardiovascular: know congenital heart lesions-cyanotic vs acyanotic, ductal-dependent lesions, and signs of heart failure (poor feeding, tachypnea, diaphoresis with feeds, failure to thrive). Understand shock recognition and cardiopulmonary resuscitation basics, including high-quality compressions and early defibrillation. Monitor for digoxin toxicity (bradycardia, vomiting, visual changes).
Traps
- Examining the throat in suspected epiglottitis-can precipitate airway obstruction.
- Treating wheezing with antibiotics-bronchodilators and steroids are key in asthma.
- Missing heart failure signs in infants (feeding difficulty, sweating during feeds).
- Using adult compression depth or rate in children.
- Forgetting to reassess after respiratory interventions.
Rule of thumb
Airway first. If the child has stridor, drooling, and tripod positioning, do not agitate or examine the mouth-keep the child calm, provide oxygen, and prepare for emergency airway management.
Worked example
A 3-year-old with asthma has RR 40, retractions, and SpO2 89%. Give oxygen, administer a bronchodilator per protocol, and reassess. If no improvement, escalate to continuous nebulization and systemic corticosteroids; prepare for advanced support.