View source for Prehospital protocol breathing difficulty (2 yo & greater)

==Decreased breath sounds or history of asthma?==

===Yes===
#Give albuterol 2.5mg/3mL NS nebulizer
#Use Cardiac Monitor/Pulse Oximetry


==Ongoing Respiratory Distress?==
===No===
#Reassess continuously during transport
#Further orders per ''Online Medical Control''

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

==IV NS TKO==
#Assess for respiratory failure

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

==Respiratory failure?==
#Increased decreased or no respiratory effort?
#Poor or absent air movement?
#Tachycardia (early sign) or bradycardia (late sign)?
#Changes in level of consciousness?
===Yes===
#Perform BVM Ventilation
#Normal saline (weight *20)ml/kg bolus IV/IO
====Begin BVM====
If BVM is not effective, perform the following:
#Reposition the airway
#Check correct mask size
#Check O2 source
#Place [[OPA]]
#Assess for gastric distention
====Is BVM Effective====
=====Yes=====
#Monitor and transport
#Call online medical control for further instructions
=====No=====
#Place endotracheal tube '''OR''' supraglottic airway

[[Category:EMS]]