Pediatric emergency medicine trisk 0202 0202

Evaluation
Breathing is assessed through observation of chest wall movement and
auscultation. Gas exchange is confirmed by auscultation and monitoring of
ETCO2 and pulse oximetry.

MANAGEMENT
Spontaneous Ventilation
Supplemental oxygen is administered to the spontaneously breathing ill patient. If
the patient is not breathing spontaneously, positive pressure ventilation (PPV) is
required. Though the optimal concentration is not known, it is reasonable to
provide 100% oxygen during CPR. Hyperoxia is a mediator of postresuscitation
injury, thus titration of FiO2 to the minimum concentration to achieve saturation
of at least 94% is recommended.

Oxygen Delivery Devices
A variety of oxygen delivery devices are available for use in patients who have
patent airways. The percent oxygen delivered depends on the child’s size and
minute ventilation.
Nasal Cannulas
One hundred percent humidified oxygen is delivered to the nares at a flow of 4 to
6 L/min. Due to entrainment of room air, the final oxygen delivery is low, usually
30% to 40%.
High-Flow Nasal Cannulas
High-flow nasal cannula (HFNC) delivers humidified and warmed oxygen/gas at
flow rates up to 12 L/min in infants and 30 L/min in children. HFNC supports
respiration though noninvasive continuous positive airway pressure (CPAP),
improved airway mechanics, reduction of metabolic expenditure, and improved
clearance of secretions. It has been used as an alternative to CPAP devices,
especially for infants with bronchiolitis. The initiation and management of HFNC
requires close monitoring by a team skilled in its use.
Oxygen Masks

There are several types of oxygen masks that offer a wide range of inspired
oxygen concentrations.