PALS | Recognition of Respiratory Failure/ Distress

🌬️ PALS: Recognizing Respiratory Distress vs. Respiratory Failure — High-Yield Study Guide⚠️ Respiratory problems are the #1 cause of pediatric cardiac arrest. Early recognition = survival.1️⃣ Respiratory Distress — The Compensation PhaseThe child is still maintaining oxygenation + ventilation by working harder.🔥 Key Signs (“WORK OF BREATHING ↑”)Tachypnea (earliest sign)Nasal flaring 👃Retractions (intercostal, suprasternal, subcostal)Head bobbing 🧠↕️ (infants)Grunting (auto-PEEP to keep alveoli open)Wheezing or stridor (depends on upper vs. lower airway)Anxious, irritable🫁 Breath SoundsUpper airway: stridor, barking coughLower airway: wheezing, prolonged expirations📈 O2 SatUsually normal or mildly low because compensation still works.2️⃣ Respiratory Failure — Decompensation PhaseThe child cannot maintain oxygenation or ventilation. CO₂ retention, hypoxemia, fatigue → arrest.🚨 Key Signs (“WORK OF BREATHING ↓ — they are giving up”)Bradypnea (late + ominous)Apnea or gaspingWeak or absent crySilent chest ❗Seesaw respirationsCyanosis 💙 (central)Poor muscle tone, floppy infantDecreased LOC → lethargy → unresponsiveness🫁 Breath SoundsVery diminished or silent chest = impending arrest.📉 O2 SatLow despite oxygen💀 Remember:Kids crash fast. Once they tire out, cardiac arrest follows within minutes.3️⃣ Causes by Category (PALS Mnemonic)Upper Airway 🟥Croup, anaphylaxis, foreign bodySigns: Stridor, hoarse voice, barking coughLower Airway 🟦Asthma, bronchiolitisSigns: Wheezing, prolonged expirationLung Tissue/Parenchymal 🟩Pneumonia, pulmonary edemaSigns: Crackles, hypoxemiaDisordered Control of Breathing 🟨Seizure, head injury, ODSigns: Irregular respirations, apnea4️⃣ Nursing Management & Immediate Actions (High Yield)In Respiratory Distress:Position: sniffing or tripodOxygen: blow-by → NC → NRBNebulizers: albuterol, racemic epi (if indicated)Suctioning for infantsAvoid agitation in upper-airway obstructionPrepare for escalation5️⃣ Red Flags You NEVER Ignore 🚩Silent chestBradypneaCyanosis unresponsive to O₂Diminishing retractions (NOT improvement—this means fatigue)Altered mental status