Prehospital protocol breathing difficulty (less than 2 yo)

Wheezing or course breath sounds?

Yes

1. Suction and give epinephrine 1:1000 3mL nebulized

Evidence of Stridor?

Yes

1. Give epinephrine 1:1000 3mL in nebulizer

No

1. Reassess continuously during transport for respiratory distress

Ongoing Respiratory Distress?

Yes

1. Give epinephrine 1:1000 3mL in nebulizer
2. Immediately assess for respiratory failure.

No

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

Signs of 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?

No

1. Continue to reassess patient

Yes

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

Is BVM effective?

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

Yes

1. Transport, monitor and continue to reassess

No

1. If continued failure to ventilate or oxygenate with BVM, then place endotracheal tube or supraglottic airway
2. Contact medical control for further orders

Authors

Daniel Ostermayer, Michael Holtz, Ross Donaldson, Neil Young