An arterial blood gas (ABG) is notneeded to document respiratory failure. Care for the patient first and intubate when necessary
An arterial blood gas (ABG) is notneeded to document respiratory failure. Care for the patient first and intubate when necessary: Excerpt from Avoiding Common Pediatric Errors
Author:
Dorothy Chen, MD
What to Do - Take Action
Respiratory failure is the inability of the respiratory system to facilitate adequate gas exchange and meet the metabolic needs of the body. Failure of the
respiratory system can be caused by abnormalities in the respiratory, neuromuscular, or central nervous system. Respiratory distress is defined as signs
of increased work of breathing, nasal flaring, use of accessory muscles, and
inspiratory retractions. This does not always accompany respiratory failure,
because respiratory failure can be due to lack of respiratory effort. Within
the pulmonary system, there can be hypoventilation, diffusion impairment,
intrapulmonary shunting or a ventilation-perfusion mismatch. Abnormal
arterial pO2 and pCO2 is found in respiratory failure, but it is not necessary
to measure and document these values prior to initiating care. Physical exam
is the key to determining respiratory failure and treatment should not be
delayed for blood gas analysis.
The ABCs of Pediatric Advanced Life Saving are vital to recognizing
respiratory failure; patients should be assessed for airway, breathing, and
circulation. The airway should be examined to be clear and maintainable
without intervention. For breathing, it is important to assess for signs of
upper and lower airway obstruction, respiratory rate, respiratory effort, the
adequacy of ventilation, use of accessory muscles, and signs of cyanosis.
When assessing circulation, evaluate responsiveness, heart rate, blood pressure, and perfusion. If respiratory failure is identified, intubation should
be initiated. Timely intervention and treatment of respiratory failure improves outcomes. The natural progression of respiratory failure will result
in pulseless cardiac arrest, so intervention should not be delayed.
ABG analysis is useful in evaluating perfusion, ventilation, and respiratory versus metabolic acidosis. However, one ABG is only a single lab value
and still needs to be considered in the context of the clinical scenario. It can
be obtained as a component of the comprehensive evaluation and as confirmation of the clinical exam, but ABGs are not required before intervening
and treating a patient for respiratory failure. The basics of Pediatric Advance Life Saving should always be initiated: access airway, breathing and
circulation.
Suggested Reading
American Academy of Pediatrics, American Heart Association. PALS Provider Manual. Dallas:
American Academy of Pediatrics, American Heart Association; 2002.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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