Lower Airway Obstruction
Asthma and bronchiolitis are among the commonest reasons children arrive breathless at an emergency department. They are the classic examples of lower airway obstruction on the PALS course.
Recognising it
Wheeze, a prolonged expiratory phase, fast breathing and increased effort. A quiet chest in a breathless, tired child is a danger sign, not reassurance.
Treatment taught in PALS includes oxygen, inhaled bronchodilators such as salbutamol (albuterol), ipratropium in more severe attacks, and corticosteroids. Magnesium sulfate and other treatments are considered in severe attacks with senior input.
A viral illness of infants. Care is mainly supportive: nasal suction, oxygen if needed, attention to feeding and hydration, and close monitoring for apnoea and tiring.
These mean respiratory failure may be developing: prepare to support ventilation and call for senior help.
If ventilation is needed, a slower rate allows time to exhale and reduces the risk of air trapping. This is discussed in the case practice on the course.
Compare upper airway obstruction and lung tissue disease. Emergency staff see these often — see PALS for emergency departments.
This guide summarises what the PALS course teaches, for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s paediatric policies.
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Narrowing of the smaller airways inside the chest, as in asthma and bronchiolitis.
Wheeze with a prolonged expiratory phase.
It can mean very little air is moving.
Mainly supportive care: suction, oxygen if needed and hydration.
Yes, as the main example of lower airway obstruction.
Paediatric emergencies are learned by doing. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with HeartCode, classroom and on-site PALS and a two-year AHA PALS Provider eCard.
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What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.
Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.