RES distress

Question 1

Possible causes of stridor

Answer 1

Croup, epiglottitis, foreign body

Question 2

Wheezing, asymmetric causes

Answer 2

Foreign body, pulmonary embolus, COPD

Question 3

Crackles, asymmetric causes

Answer 3

Pneumonia, pulmonary edema

Question 4

Clear, asymmetric or absent causes

Answer 4

Pneumothorax, pulmonary embolus, COPD

Question 5

Wheezing, symmetric causes

Answer 5

Asthma, pulmonary edema, COPD

Question 6

Crackles, symmetric causes

Answer 6

Pulmonary edema, extensive pneumonia

Question 7

Clear, symmetric causes

Answer 7

Hyperventilation, MI, metabolic, pulmonary embolus

Question 8

If the patient remains in severe respiratory distress (e.g., unable to speak
more than one or two words, low O2 saturation [< ___%], RR > __)
start CPAP if available

Answer 8

90, 40

Question 9

Furosemide (if SBP > ___mmHg and fluid overload state [JVD, rales,
peripheral edema, hypertension]).

Answer 9

100

Question 10

Dose of lasix if they are currently taking vs if they dont take

Answer 10

20 if they dont 40 if they do

Question 11

COPD treatment

Answer 11

a. DuoNeb (albuterol and ipratropium) by nebulizer. May repeat twice as needed.
b. If patient has severe respiratory distress administer dexamethasone (Decadron·
10 mg IV, IO, IM, or PO.
c. If the patient remains in moderate to severe respiratory distress (e.g., unable to
speak more than one or two words, low O2 saturation (< 90%), RR > 40) administer
CPAP if available.
d. If clinically indicated, administer continuous nebulized albuterol treatment.

Question 12

Asthma treatment

Answer 12

a. DuoNeb (albuterol and ipratropium) by nebulizer. May repeat twice as needed.
b. If patient has moderate to severe asthma based on the Severity Assessment Guide,
administer dexamethasone (Decadron·) 10 mg IV, IO, IM, or PO.
c. If patient is deteriorating, administer 1:1,000 epinephrine 0.3 to 0.5 mg IM.
d. If patient condition does not improve, consider magnesium sulfate (2 grams over
20 minutes).
e. If clinically indicated, administer continuous nebulized albuterol treatment.
f. Consider CPAP if available.

Question 13

Peds Upper Airway Obstruction treatment

Answer 13

a. In patients 6 months to 6 years of age with audible stridor at rest, administer 5 mL
epinephrine 1:1,000 or racemic epinephrine 11.25 mg (0.5 mL) diluted in 2.5 mL
normal saline, nebulized. May repeat once. Contact OLMC for additional dosing.
b. Suspected anaphylaxis or foreign body:
i. Treat anaphylaxis and foreign body obstruction per adult guidelines.
c. Suspected croup, epiglottis, or laryngeal edema:
The usual cause of respiratory arrest in children with croup, epiglottitis or laryngeal
edema is exhaustion, not complete obstruction.
i. If suspected croup, administer dexamethasone per peds guide.
ii. If the child deteriorates, perform BVM.
iii. If unable to ventilate with BVM, perform intubation.
iv. If intubation unsuccessful and unable to ventilate effectively, perform needle
cricothyrotomy.

Question 14

Peds asthma

Answer 14

a. Administer albuterol and ipratropium per adult guidelines.
b. If patient is deteriorating administer 1:1,000 epinephrine 0.01 mg/kg IM
(MAX dose 0.5 mg). Contact OLMC for additional doses.
c. If patient has Moderate to Severe asthma based on Asthma Severity Assessment Guide
and is not improving with treatment, consider dexamethasone 0.6 mg/kg IV/IO/IM/PO
up to 10 mg.
d. If patient condition does not improve, consider magnesium sulfate (50 mg/kg over
20 minutes)

Question 15

BRUE

Answer 15

(Brief Resolved Unexplained Event)

Question 16

BRUEs are most common in infants ___, but may occur up to
two years of age. They are more frequent in premature infants and infants with other
health conditions such as cystic fibrosis, bronchiolitis and congenital heart disease

Answer 16

under one year of age

Question 17

Acute Bronchiolitis (< 2 years old)

Answer 17

Mild-moderate respiratory distress (see Infant Respiratory Distress Guide below)
a. Administer oxygen via blow-by, nasal cannula or mask to keep SpO2
> 92%.
Monitor EtCO2
if available.
b. If nasal secretions and/or congestion, use nasal suction with adapter if available.
If secretions are thick, may use normal saline to loosen.
c. If wheezing, administer albuterol 2.5 mg via nebulizer. If improvement, may use every
10 minutes. Discontinue if patient’s heart rate is > 200.
d. If patient worsens and is still wheezing, administer epinephrine 5 mL of 1:1000
via nebulizer.
If improvement, may use every 10 minutes. Discontinue if patient’s heart rate is > 200.
e. If unable to keep SpO2
> 92% with oxygen or patient has continued significant work
of breathing despite treatment:
i. 30-90 days old: titrate High Flow Nasal Cannula (pediatric) Oxygen (HFNCO)
starting at 2 LPM up to 4 LPM.
ii. Greater than 90 days old: titrate High Flow Nasal Cannula Oxygen up to 6 LPM