Respiratory Distress

Question 1

Epinephrine Dose (Imminent respiratory failure)

Answer 1

0.3 mg (0.3 ml of 1mg/kg) IM
If no response: 0.3 mg (3 ml of 0.1 mg/ml) IV

Question 2

Adult Asthma Treatments

Answer 2

• Albuterol 2.5-5 mg until symptoms improve
• Consider duoneb in nebs #2 & #3
• Solu-Medrol 125 mg IV x 1 dose
• Consider Mag Sulfate 2 gms IV over 20 min. Mix 2 gm Mag in 100 ml NS
• Epi for Imminent respiratory failure

Question 3

Chronic Lung Disease w/ deterioration

Answer 3

• Albuterol 2.5-5 mg until symptoms improve
• Consider duoneb in nebs #2 & #3
• Solu-Medrol 125 mg IV x 1
• Impending respiratory failure, give continuous Albuterol diluted w/ 3 ml of saline. (Duoneb only in HHNS #2 & #3)
• Consider placing pt on BiPAP

Question 4

Pulmonary Edema

Answer 4

• Position patient sitting up as blood pressure will tolerate
• Administer NTG 0.4 mg SL or NTG 0.4 mg (2ml) IVP, q 5min up to 3 if SBP >100 mmHg while preparing to initiate Nitroglycerin infusion at 50-200 mcg/min to keep SBP >90 mmHg and titrate to effect. Nitroglycerin premix is 50 mg in 250 ml D5W (200mcg/mL)
• Furosemide 40 mg IV/IO over 5 minutes if not currently taking at home, or the equivalent of one dose of their home oral regimen IV/IO. (No order needed)
• Consider assisting breathing with BVM + use of PEEP valve to provide
  noninvasive positive pressure ventilation. Begin with a PEEP setting of 8 cmH2O and adjust as necessary to a maximum of 10 cmH2O
• Consider implementation of BiPAP on Hamilton Ventilator

Question 5

PNEUMOTHORAX

Answer 5

Watch for signs/symptoms of tension physiology. If patient deteriorates rapidly, perform a needle thoracostomy on the affected side according to procedure. If needle thoracostomy x2
unsuccessful, proceed to simple thoracostomy
- Consider chest tube insertion upon definitive confirmation of a significant
pneumothorax or hemothorax by x-ray or ultrasound and with MD order

Question 6

Four signs that suggest imminent respiratory arrest in a patient with acute respiratory distress

Answer 6

• Decreasing level of consciousness
• Rising ETCO2
• Inability to maintain respiratory effort
• Cyanosis

Question 7

Pediatric Asthma

Answer 7

• Albuterol:
  <12 years old: 0.15mg/kg (max dose of 2.5 mg) q 20 minutes for 3 doses
  followed by 0.5mg/kg/hr diluted in 3 ml saline for continuous nebulization
  ≥12 use the adult dose
• Epinephrine 0.01mg/kg of 1 mg/ml up to 0.3mg IM
• Impending respiratory failure: Epinephrine 0.01mg/kg (0.1mg/ml) IV/IO to max dose of 0.3mg
• Administer Methylprednisolone 0.5-1mg/kg x 1 dose
• Consider Magnesium Sulfate 50 mg/kg up to 2 gm in NS 100ml; administer over 20 minutes.
• Call medical control if interventions unsuccessful and terbutaline required. Terbutaline 0.01 mg/kg, max dose of 0.4mg

Question 8

Peds: STRIDOR OR HYPOXIA RELATED TO CROUP OR EPIGLOTTITIS

Answer 8

• Allow the patient to remain sitting upright if alert.
• Racemic Epinephrine (2.25%):
  < 6 months of age nebulizer- 0.25ml
  >6 months nebulizer-0.5ml; may repeat in 20 minutes
• Assure adequate hydration with maintenance IV fluids (Pediatric Dehydration
  Protocol)