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Respiratory Distress
in Paediatrics:
Causes, Indicators
and Early Management.
My name is Hannah
Bellsham-Revell.
I'm a Paediatric Cardiologist at
Evelina London
Children's Hospital.
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Signs of respiratory distress.
Use of accessory muscles,
so working hard,
is a sign of
respiratory distress.
This can include nasal
flaring, tracheal tug,
intercostal and
subcostal recession,
use of shoulder
muscles and grunting,
otherwise known as auto-PEEP.
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Clinical evaluation.
End of the bed.
What can you see?
Is the patient using
accessory muscles?
What is the respiratory rate?
Are there added noises?
Like wheeze, which is expiratory
or stridor, which
is inspiratory.
What can you feel?
Crepitations, chest wall motion.
What can you hear?
Crackles, crepitations,
wheeze or stridor.
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Common conditions
in paediatrics.
Bronchiolitis. This is
small airway inflammation
usually presents under
1-2 years of age
with crackles and wheeze,
wet spluttery cough,
prolonged exhalation
often with coryza
and then maybe patchy
changes on the chest X-ray.
Heart failure. This can
present at any age,
and may or may not
have a murmur.
Breathlessness, maybe crackles,
and other adult signs,
although in smaller children,
hepatomegaly, pulmonary
oedema on chest X-ray
with an increased heart
size may be of more use.
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Chest infection or pneumonia.
Fever with a cough, possible
chest X-ray changes
and focal chest signs may point
towards a chest
infection or pneumonia.
Asthma is associated
with wheeze,
prolonged expiratory phase
and may or may not have an
intercurrent infection.
Croup presents with stridor
and respiratory distress.
Foreign body inhalation may
present with stridor or wheeze,
depending on where the
foreign body gets stuck.
It is important to note that
in asthma, croup and
foreign body inhalation,
desaturation is a late sign.
If you have a patient who
is already desaturated,
that is a worrying sign.
Early management. ABC approach.
