2.06P - Bronchospasm / Respiratory Distress (Pediatric)

EMT-Basic (Standing Orders)

1.0 Routine Patient Care
MILD DISTRESS:
The following may be considered if the patient has not taken the prescribed maximum dose of their own inhaler prior to the arrival of EMS: and the inhaler is present:

Encourage and/or assist patient to self-administer their own prescribed inhaler medication if indicated or if not already done.
If patient is unable to self-administer their prescribed inhaler, administer patient’s prescribed inhaler.
Reassess vital signs.

MEDICAL CONTROL MAY ORDER:

Additional doses of above medications, if prescribed to patient or authorized, and if maximum dose has not been administered.
NOTE: EMT-B and AEMT administration of an inhaler is CONTRAINDICATED, if:

The maximum dose has been administered prior to the arrival of the EMT.
The patient cannot physically use the device properly. (Patient cannot receive inhalation properly.)
The device has not specifically been prescribed for the patient.
**If properly trained and authorized, use6.1 BLS Albuterol.

SEVERE DISTRESS:

If patient is over 6 months age and under 25kg, administer epinephrine 0.15mg via auto-injector or IM.
If body weight is over 25 kg, administer epinephrine 0.3mg via auto-injector or IM.
When administering IM, EMTs may do so in accordance with Protocol6.6 Check and Inject Epinephrine for BLS Providers.
Contact Medical Control if second dose is required after 5 minutes.

Criteria for epinephrine administration:

Age greater than or equal to 6 months
Known history of asthma or reactive airway disease or bronchospasm or bronchodilators prescribed AND
Patient in respiratory arrest or approaching respiratory arrest(requiring BVM) - include:

Diminished or absent breath sounds AND
Oxygen saturation less than 91% despite supplemental oxygen or unmeasurable.

EMT-Advanced (Standing Orders)

If the condition is not improving with administration of supplemental oxygen, consider the following:
Albuterol sulfate 1.25 mg with ipratropium bromide, 250 mcg via nebulizer if less than 2 years of age.
Albuterol sulfate 2.5-3 mg with ipratropium bromide, 500 mcg via nebulizer if age 2 years or greater.
A second dose of albuterol, with or without ipratropium bromide, may be administered as necessary.

Note: a multi-dose inhaler may be used to give albuterol or ipratropium (instead of nebulizer) if infection control is an issue (e.g., influenza-like-illness).ADVANCED EMT STANDING ORDERS

SEVERE DISTRESS:

If patient is over 6 months age and under 25kg, administer epinephrine 0.15mg via auto-injector or IM. If body weight is over 25 kg, administer epinephrine 0.3mg via auto-injector or IM.
Contact Medical Control if second dose is required after 5 minutes

EMT-Paramedic (Standing Orders)

For a child age 2 years old or more who has a known diagnosis of asthma, consider:
- hydrocortisone 2 mg/kg to max. 100 mg IV/IO/IM; or
- methylprednisolone 2 mg/kg to max. 125 mg IV/IO/IM.
Consider magnesium sulfate 25 mg/kg IV/IO over 10 min. (maximum dose 2 grams).

EMT-Paramedic (Medical Control)

Additional doses of above medications.

Caution:

Epinephrine for anaphylaxis must be administered by Auto-Injector or IM if trained and authorized to do so in accordance with:Medical Director Option Protocol 6.6 Check and Inject Epinephrine for BLS Providers

Caution:

For patients under 12 years old, the airway is in most cases best managed with a BVM or SGA.

In some cases, intubation may be preferred. This is at the discretion of the treating paramedic.

Note:

Mild distress in children is evidenced by minor wheezing and good air entry.

Severe distress in children is evidenced by poor air entry, extreme use of accessory muscles, nasal flaring, grunting, cyanosis and/or altered mental status (weak cry, somnolence, poor responsiveness). REMEMBER: Severe bronchospasm may present without wheezes, if there is minimal air movement.

Respiratory Distress is defined as inadequate breathing in terms of rate, rhythm, quality and/or depth of breathing. Children who are breathing too fast or slow, or in an abnormal pattern or manner, may not be receiving enough oxygen to support bodily functions and may allow an increase in carbon dioxide to dangerous levels. Cyanosis is usually a late sign and requires immediate treatment.

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