Pediatric Airway Emergencies: What LNCs Should Look For

A pediatric airway emergency can become life-threatening within minutes. Children have smaller airways, higher oxygen demands, and less reserve than adults. A delay in recognizing respiratory distress, a missed change in assessment findings, or poor communication among healthcare providers can have devastating consequences.

For attorneys handling these cases, the medical records tell the story of what happened—or what didn’t. Where we come in as LNCs is being well-positioned to identify the details that reveal whether the standard of care was met.

A thorough medical record review goes beyond finding obvious documentation gaps. It requires understanding the sequence of events, recognizing subtle changes in the child’s condition, and determining whether the healthcare team responded appropriately.

Start with the Timeline

One of the first tasks is creating a detailed chronology for a pediatric airway emergency.

• When did the child first show signs of respiratory compromise?
• What did the healthcare provider do then, if anything?
• How much time elapsed before the physician/nurse practitioner/physician assistant was notified?
• When was respiratory therapy called?
• When was the physician or advanced practice provider at the bedside?
• How long did it take before definitive action occurred, such as intubation or the child was transferred to a higher level of care?

Minutes matter in pediatric airway emergencies. A well-developed timeline often reveals delays that may not be apparent when reading individual notes in isolation.

Compare nursing documentation, physician notes, respiratory therapy documentation, medication administration records, monitor data, and electronic health record time stamps. Small discrepancies between these sources may become significant.

This type of comparison requires human action; AI may miss the subtleties. This becomes a selling point for why an LNC is critical.

Pay Close Attention to Respiratory Assessments

One of the most valuable contributions an LNC can make is evaluating whether respiratory assessments accurately reflected the child’s condition as the pediatric airway emergency evolves.

Look for documentation describing:

• Respiratory rate
• Work of breathing
• Retractions
• Nasal flaring
• Grunting
• Stridor
• Wheezing
• Diminished breath sounds
• Cyanosis
• Oxygen saturation
• Level of consciousness
• Skin, lips, and nailbed color
• Capillary refill time

The absence of these assessment findings can be as meaningful as their presence. Generic statements such as “no distress” may conflict with objective data recorded elsewhere in the chart.

For example, a child with falling oxygen saturation, increasing respiratory rate, and documented retractions should not simultaneously be described as resting comfortably – without further explanation.

Watch for Trends Rather Than Isolated Findings

An oxygen saturation of 94% may not appear alarming on its own.

However, if the saturation steadily declined from 99% to 97%, then 95%, then 94% while the child required increasing oxygen support, the trend tells a very different story.

The same applies to:

• Heart rate
• Respiratory rate
• Blood pressure
• Mental status
• Blood gas results
• Oxygen delivery requirements

LNCs should organize these values chronologically to determine whether the staff recognized a pediatric airway emergency early enough.

Review Communication Carefully

Communication failures frequently play a role in pediatric airway emergency cases, as they do in many medical malpractice cases.

Look for documentation showing:

• When nurses notified providers
• What information was communicated
• Whether the provider examined the child promptly
• Whether new orders were received
• Whether recommendations from respiratory therapy were communicated
• Whether concerns were escalated through the chain of command

Many charts contain brief entries such as “physician notified.”

That statement raises several questions.

• What prompted the call?
• Who made the call?
• Who was notified?
• What clinical information was shared?
• What orders were received?
• Did the provider come to evaluate the patient?
• Did the child’s condition continue to deteriorate afterward?

The answers often require comparing multiple sections of the medical record.

Evaluate Medication Administration

Medication timing can become an important issue.

Review whether ordered medications were given promptly, including:

• Nebulized bronchodilators
• Racemic epinephrine
• Corticosteroids
• Antibiotics when indicated
• Sedation medications
• Emergency medications during resuscitation

Also, examine the child’s response.

• Did the bedside staff document a change in the patient’s condition?
• Did the documentation describe improvement?
• Was additional treatment required?
• If so, was it provided?
• Did caregivers reassess the patient after medication administration?

Failure to document reassessment may leave unanswered questions about whether treatment was effective or whether the patient’s bedside nurse performed the reassessment.

Examine Airway Management Documentation

When intubation becomes necessary, the documentation should provide a detailed picture of what occurred.

Review records for:

• Indication for intubation
• Personnel performing the procedure
• Equipment used
• Tube size
• Number of attempts at insertion of the endotracheal tube
• Confirmation of correct tube placement
• Oxygen saturation during the procedure
• Complications encountered
• Post-intubation assessment

Repeated unsuccessful attempts may contribute to worsening hypoxia and should be carefully analyzed.

Consider Age-Specific Standards

Children are not simply small adults.

Normal respiratory rates, heart rates, medication dosages, and airway anatomy vary considerably by age.

An infant with a respiratory rate of 60 may be within expected limits under some circumstances, while the same rate in an older child could indicate significant distress.

Similarly, subtle behavioral changes such as decreased activity, poor feeding, irritability, or lethargy may represent early signs of respiratory compromise in infants who cannot verbalize their symptoms.

Understanding age-specific assessment findings helps LNCs identify documentation that deserves closer examination.

Look Beyond the Narrative Notes

Important information is often scattered throughout the record.

Do not rely solely on physician or nursing notes.

Review:

• Flow sheets
• Continuous monitoring records
• Respiratory therapy notes
• Medication administration records
• Laboratory results
• Radiology reports
• Code documentation
• Rapid response records
• Electronic audit trails when available

Comparing these sources often reveals inconsistencies or missing documentation that warrant further investigation.

Your Analysis Can Strengthen the Attorney’s Case

Pediatric airway emergencies involve rapidly evolving clinical situations in which early recognition and prompt intervention can make the difference between recovery and permanent injury.

By organizing the chronology, identifying subtle changes in respiratory status, evaluating communication among providers, and comparing documentation across multiple parts of the medical record, LNCs provide attorneys with a clear understanding of what occurred.

Your ability to recognize patterns that someone without a clinical background may overlook helps attorneys assess liability, identify additional discovery questions, and prepare stronger cases.

When minutes matter, careful record analysis matters just as much.