Page 48 - 2026 SMOG

LOWER RESPIRATORY DISTRESS
Signs and Symptoms Potential Causes
• Shortness of breath • Asthma
• Pursed lip breathing • Anaphylaxis/allergy
• Decreased ability to speak • Aspiration
• Tachypnea/hyperpnea • COPD
• Wheezing/rhonchi/rales • Pleural effusion
• Use accessory muscles • Pneumonia
• Fever/cough • Congestive heart failure/cardiac
• Tachycardia • Pulmonary embolus
• Absent breath sounds • Pneumothorax
• Pericardial tamponade
• Hyperventilation
• Toxic inhalation (e.g., cyanide, CO)
ADULT PEDIATRIC
Wheezes Wheezes
• Monitor O and EtCO 2 • Place on 100% oxygen via NRB
2
• Place on 100% oxygen via NRB • Administer Albuterol 2–4 actuations q4–6hr
• Administer Albuterol 2–3 actuations (90mcg (90mcg MDI) or 2.5–5mg nebulized q20min
MDI) prn or 2.5–5mg nebulized (Max 3 doses)
• Monitor for allergic reactions • Monitor for allergic reactions
˚ Consider Epinephrine 1mg/mL 0.3–0.5mg ˚ Consider Epinephrine (1:1000)
IM (EpiPen)
15–30kg give 0.15mg IM (EpiPen JR)
• Initiate IV/IO Access ˚ ˚ >30kg give 0.3mg IM (EpiPen)
• Administer Methylprednisolone 125mg IV OR
• Consider Magnesium Sulfate 2g IV over 20min. ˚ 0.01mg/kg IM (max 0.3mg)
Dilute in 50–100mL NS or D5W • Administer Methylprednisolone 2mg/kg IV
(See drug card for maintenance dose)
• Administer Magnesium Sulfate 25–50mg/kg
IV over 15–30min (max 2g) diluted in
50–100mL NS
Rales/CHF Rales/CHF
• Monitor O and EtCO 2 • Monitor O and EtCO 2
2
2
• Provide PPV/NIPPV (CPAP/BIPAP) with 100% • Provide PPV (if tolerated) with 100% oxygen
oxygen support support
• Initiate IV/IO Access OR
• Administer Nitroglycerin SL 0.4mg q5min if • 100% NRB if PPV is not tolerated
SBP >90 • Failure to improve
• Failure to improve: ˚ Administer Furosemide 1mg/kg IV slow
˚ Administer Furosemide 40mg IV over push; place Foley if possible.
1–2min, place Foley if possible
Notes, Cautions, Warnings
• SpO <90% or respiratory status continues to deteriorate, consider definitive airway control.
2
• Albuterol can be administered with a spacer or a short (6") section of ventilator tubing to increase
delivery if the patient is unable to perform the action appropriately.
• Lack of abnormal breath sounds does not always signify improvement. As respiratory status worsens,
there may be inadequate air movement to produce these sounds.
Reference: ARC PALS (2020)
40 • MEDICAL