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Medical

PEDs RESPIRATORY DISTRESS

Signs and Symptoms: Differential Diagnosis:
• Shortness of Breath • Asthma
• Tri-Pod Position • Anaphylaxis/Allergy
• Pursed Lip Breathing • Aspiration
• Decreased Ability to Speak • Croup
• Tachypnea/Hyperpnea • Pneumonia
• Wheezing/Rhonchi/Rales • Epiglottitis
• Use Accessory Muscles • Pneumothorax
• Fever/Cough • Pericardial Tamponade
• Tachycardia • Hyperventilation
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• A Absent Breath Sounds s • Toxic Inhalation (e.g., Cyanide, CO)
Universal Patient Care Protocol
AIRWAY Pediatric Indications of:
Consider: Respiratory Insufficiency Position to
Early establishment of YES Fatigue? NO Patient Comfort Monitor O2 Sat
Advanced Airway! (*See Pearls)
Rales Wheezes Stridor
PPV (if patient can tolerate) 100% O2 via NRB View for Obstruction:
Otherwise, (jaw-thrust for c-spine injury)
Albuterol 90mcg MDI
100% O2 via NRB 180mcg (2 puffs) every 4-6 hours • Suction prn
Not to exceed 12 metered doses q24hr 100% O 2 via NRB
IV/IO Protocol OR
2.5mg nebulized Consider:
O2 Sat <90% or respiratory
If Failing to Improve, Consider: status continues to deteriorate: Pediatric
Furosemide 1mg/kg IV (Place Consider Epinephrine ALLERGIC
Foley if possible) >30kg: 1:1,000 0.3mg IM (EpiPen) PEDs AIRWAY Protocol REACTION
15-30kg: 1:1,000 0.15mg IM (EpiPen Jr)
OR (for all PEDS) Nebulized Racemic Epinephrine
1:1,000 0.01mg/kg (max 0.3mg) IM (1:1,000): 0.5mL/kg (maximal dose: 5mL)

Consider Epinephrine
IV / IO Protocol >30kg: 1:1,000 0.3mg IM (EpiPen)
15-30kg: 1:1,000 0.15mg IM (EpiPen Jr)
Methylprednisolone 1-2mg/kg IV OR (for all PEDS)
and 1:1,000 0.01mg/kg (max 0.3mg) IM
Last resort: • Magnesium Sulfate 25-75mg/kg
Ketamine 0.5mg/kg IV Bolus IV over 30min (Max 2g)-bolus IV / IO Protocol
(SLOW PUSH) with 20mL/kg crystalloid Methylprednisolone 1-2mg/kg IV
Pearls:
• Signs of respiratory insufficiency: Cyanosis, altered mental status/loss of consciousness, fatiguing, inability to speak, or inability to maintain O2 sat
>94% with supplemental O2.
• Albuterol can be administered with spacer or short (6”) section of ventilator tubing to increase delivery if patient unable to perform action
appropriately. No max dose of albuterol, repeat as needed for continued wheezing.
• Lack of abnormal breath sounds does not always signify improvement. As respiratory status worsens, there may be inadequate air movement to
produce these sounds. In pediatric patients (especially infants), respiratory insufficiency may be the result of cardiac anatomical anomalies, in addition
to standard causes. Peripheral cyanosis is a clue to this condition, and suspicion should be reported to accepting providers upon arrival.
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