Prehospital protocol breathing difficulty (2 yo & greater)

Decreased breath sounds or history of asthma?

Yes

1. Give albuterol 2.5mg/3mL NS nebulizer
2. Use Cardiac Monitor/Pulse Oximetry

Ongoing Respiratory Distress?

No

1. Reassess continuously during transport
2. Further orders per Online Medical Control

Yes

1. Continuous albuterol nebulizer during transport
2. Ipratropium bromide 0.02% 2.5mL (add to albuterol), max of 3 doses
3. (weight *0.6)mg PO dexamethasone (max 16mg) or methylprednisolone (weight *2)mg IV/IM (max 125mg)
4. Assess for respiratory failure.

IV NS TKO

1. Assess for respiratory failure

Signs of respiratory failure?

1. Give epinephrine 1:1000 (weight *0.01)mg IM (max 0.3mg)
2. Give magnesium sulphate (weight x 40)mg (in 50mL NS) IV over 10 min (max 2 grams)
3. Begin CPAP (3-5cm H20 PEEP) if appropriate mask is available

Respiratory failure?

1. Increased decreased or no respiratory effort?
2. Poor or absent air movement?
3. Tachycardia (early sign) or bradycardia (late sign)?
4. Changes in level of consciousness?

Yes

1. Perform BVM Ventilation
2. Normal saline (weight *20)ml/kg bolus IV/IO

Begin BVM

If BVM is not effective, perform the following:

1. Reposition the airway
2. Check correct mask size
3. Check O2 source
4. Place OPA
5. Assess for gastric distention

Is BVM Effective

Yes

1. Monitor and transport
2. Call online medical control for further instructions

No

1. Place endotracheal tube OR supraglottic airway

Authors

Daniel Ostermayer, Michael Holtz, Neil Young, Ross Donaldson