As a respiratory therapist at a local hospital, I was called to the Emergency Department to await the arrival by ambulance of a 32 lb. (14.54 kg.), eighteen-month old male toddler with a history of coughing, congestion, fever, and runny nose for the previous five days. He is currently taking prescribed medication, by his pediatrician, consisting of acetaminophen to control fever as well as cough syrup to lessen his cough, congestion and runny nose. He has been on this medication for the past two days but suddenly, within the past hour, has developed an audible wheeze and cyanosis around his lips. This change in condition alarmed his mother and she called 911 to have an ambulance come to her home.
While in route to the hospital, the EMS reported the following vital signs: a temperature of 103.9 degrees F, heart rate of 170, respiratory rate of 48, blood pressure of 112/74, and 78% oxygen saturation on room air. The EMS team placed the patient on 100% oxygen using a non-rebreather mask and got his oxygen saturation to improve to 90%. They also administrated two 2.5 mg. Albuterol treatments. This toddler was in respiratory distress and needed additional treatment as soon as he arrived at the hospital.
To prepare for the patient’s arrival, and likely intubation due to his low oxygen saturation, I gathered the equipment required. A Servoi ventilator would be brought into the room. The monitors required are an EKG, pulse oximeter, blood pressure, end-tidal Co2, and stethoscope. The airway required is an un-cuffed size 4.5 internal diameter endotracheal tube which is recommended for a child 1-to-2 years old, as well as a size 4 and a size 5 to be sure the best size is available. The suctioning equipment would include an in-line suctioning catheter and Yankour connected to 80 mm Hg of suction with collection canister. To place and secure the endotracheal tube, a stylette, straight Miller blade, laryngoscope, forceps, 1-inch tape kit and benzoin would be used. Also a BVM with a pediatric size mask would be attached to an oxygen
flow meter set at 15 L and ready to be used (Walsh 222-23).
When the EMS team arrived at the hospital, the patient was pale and irritable and in severe respiratory distress while still receiving a nebulized Albuterol treatment. Cyanosis was now evident both peripherally and centrally. While crying, his oxygen saturation dropped to 70% but was able to return to 90% when calmed. A rapid cardiopulmonary assessment was performed. His general appearance was pale. He was conscious and moving all extremities. His respiratory rate was 48 and fast for his age. The normal rate for a patient his age is 25-40 (Des Jardins 124). Breath sounds revealed bilateral diffuse wheezes. His circulation was poor as evident by his peripheral cyanosis. To prevent further deterioration of his condition, the patient was intubated and oxygenated via the BVM. The intubation was successful and verified by equal bilateral breath...