This protocol includes most etiologies for wheezing in the pediatric patient including asthma, bronchospasm, bronchiolitis, reactive airway disease, and congenital abnormalities of the large airways such as laryngo- or tracheomalacia.
Follow General Pediatric Protocol.
Mandatory interventions:
a. Oxygen
b. If severe distress, initiate IV access
Assess for level of respiratory difficulty:
a. Mild
i. Coarse respirations, oxygen saturation 95 – 100%, normal skin color, minimal or no retractions/nasal flaring
b. Moderate
i. Coarse respirations, oxygen saturation 90 – 95%, normal skin color, retractions/nasal flaring may be present, normal level of alertness
c. Severe
i. Coarse respirations (but may have a “silent chest”), oxygen saturation < 90%, cyanosis, retractions/nasal flaring present, decreased level of alertness
DYSPNEA / ASTHMA / BRONCHOSPASM
Administer ALBUTEROL SVN:
a. < 2 y/o: ALBUTEROL 1.25 mg (0.25 mL)
b. > 2 y/o: ALBUTEROL 2.5 mg (0.5 mL)
May repeat every 15 – 20 minutes as needed.
If severe respiratory distress, contact Medical Control:
a. Request orders for EPINEPHRINE 1:1,000 0.01 mg/kg (0.01 mL/kg) SQ (maximum single dose 0.3 mg).
FOREIGN BODY OBSTRUCTION
If the patient is making attempts to clear the airway without success, you may assist with careful back blows (infants only), chest or (gentle) abdominal compressions.
If the patient loses consciousness, attempt to open the airway and ventilate. Reposition and attempt to ventilate again if necessary. If unsuccessful, perform standard obstructed airway maneuvers.
If unable to remove by any method, attempt to blow obstruction further into right or left bronchial tree. Intubate if needed.
Emergent transport should be initiated early during any choking episode.
STRIDOR / CROUP
Differential diagnosis for stridor includes foreign body obstruction (above), croup, and epiglottitis.
Manipulation and examination of an alert child who is breathing on his own should be kept to an absolute minimum.
Administer oxygen in the least stimulating manner. (If saturation > 92%, can forgo oxygen administration).
If safe to do so, allow child to sit on parents’ lap during transport (with parent on cot).
Administer cool nebulized saline mist via SVN
Administer DEXAMETHASONE (Decadron) 0.6 mg/kg IV/IM/PO (maximum 8 mg)
Contact Medical Control to alert for potential airway emergency. Prepare to insert an adjunctive airway, supraglottic airway, or perform endotracheal intubation as the circumstances dictate.