Pediatric Respiratory/Asthma/Croup Administrative Guideline (Age < 14)

Question 1

History

Answer 1

- Asthma; COPD -- chronic bronchitis, 
emphysema, 
- Congestive heart failure
- Home treatment (oxygen, nebulizer)
- Medications (theophylline, steroids, 
inhalers)
- Toxic exposure, smoke inhalation

Question 2

Signs and Symptoms

Answer 2

• Shortness of breath
• Decreased ability to speak
• Increased work of breathing/accessory
  muscle use
• Wheezing, rhonchi
• Fever, cough
• Tachycardia

Question 3

Differential

Answer 3

• Asthma
• Anaphylaxis
• Aspiration/inhaled foreign body
• Croup
• Pneumonia
• Pulmonary embolus
• Hyperventilation
• Inhaled toxin (Carbon monoxide, etc.)

Question 4

Do they have respiratory distress/wheezing/stridor?

Answer 4

First steps:
Administer oxygen and titrate to SaO 2 of ? 94%
Place in position of comfort
Consider anaphylaxis/allergic reaction AG

Question 5

Wheezing on lung examination, history of asthma/COPD

Answer 5

Administer albuterol SVN if available

IV access if indicated, EtCO 2 if indicated

Administer albuterol 2.5 mg SVN; May repeat as needed.
Administer ipratropium (Atrovent) nebulized with albuterol;
May repeat albuterol x 2

For severe respiratory distress consider administration of magnesium sulfate 25 mg/kg (max dose 2 g) IV over 20 minutes.

Question 6

Stridor with croup suggested

Answer 6

Avoid IV placement
Consider nebulized epinephrine (1mg/mL)
3 mL by SVN
May repeat x 1 in 20 minutes

Question 7

Wheezing or stridor second step

Answer 7

Administer methylprednisolone 2 mg/kg IV/IM

max dose 125 mg

Question 8

No clinical improvement/continued respiratory distress

Answer 8

Consider administration of epinephrine (1 mg/mL) 0.01 mg/kg IM
max dose = 0.3 mg IM

Question 9

Grade 1 croup

Answer 9

exertion causes dyspnea or stridor

Question 10

Grade 2 croup

Answer 10

stridor is present at rest, and worsens with exertion

Question 11

Grade 3 croup

Answer 11

stridor and retractions of the sternal chest wall are present at rest.

Question 12

Grade 4 croup

Answer 12

respiratory distress, irritability, pallor or cyanosis, tachycardia, and exhaustion are present at rest.

Question 13

How to make nebulized epi

Answer 13

Epinephrine (using parenteral 1 mg/mL solution): Nebulization: 3 mL of 1 mg/mL solution. May repeat x 1 in 20 minutes.