1. If patient breathing:
Standing Orders
a. Begin oxygen therapy.
b. Move patient to ambulance and begin transport. Asthma patients should always be transported to a hospital for monitoring and further treatment.
c. Give nebulized albuterol2.5 mg with Atrovent0.5 mg added. May repeat albuterol neb 2.5 mg with Atrovent 0.5 mg x1.
d. Contact a medical control physician for patients with continued moderate-to-severe respiratory distress after two nebs.
After Obtaining Verbal Orders
e. Consider ET intubation.
f.
Consider terbutalineor epinephrine0.01mg/kg 1:1000 (0.01
cc/kg) SC.
Maximum dose = 0.25 cc terbutaline or 0.3 cc epinephrine (to be used in field
only if condition severe).
g. If unresponsive to other treatments and in impending respiratory failure, may consider magnesium sulfate 25 mg/kg IV
2. If patient in respiratory arrest:
Standing Orders
a. Insert oral airway and begin positive pressure ventilation. Ventilate with short insp:long exp ratio at rate of 8-10/min.
b. Insert Combitube(if patient meets size requirements) or, if authorized, ET tube as soon as possible.
c. May administer Terbutaline0.01 mg/kg (0.01 cc/kg) SC maximum dose = 0.25 mg while awaiting contact with a medical control physician.
d. If ET intubated give in-line nebulized albuterol2.5 mg with Atrovent0.5 mg added. May repeat neb of albuterol 2.5 mg with Atrovent 0.5 mg x1.
e. If lung deflation poor, perform manual exhalation.
f. Start IV Normal Saline and attach ECG leads while contacting a medical control physician.
g. Expedite transport.
2. If patient in respiratory arrest (con’t):
After Obtaining Verbal Orders
h. If terbutalinenot already given consider terbutaline or epinephrine0.01 mg/kg 1:1000 (0.01 cc/kg) SC. Maximum dose = 0.25 cc terbutaline or 0.3 cc epinephrine.
i. If unresponsive to other treatments and in impending respiratory failure, may consider magnesiumsulfate 25 mg/kg IV.
j. If patient ET intubated and becomes agitated from increased level of consciousness:
- Consider Versed0.1 mg/kg titrated up to 1mg IV, IM, or SC.
- May repeat
k. Consider Atropine0.02 mg/kg or 0.2 cc/kg IV/IO up to 5 cc for child or 10 cc for adolescent (minimum dose 0.1 mg or 1 cc). May be repeated once in 5 minutes.
l. Consider Sodium Bicarbonateif arrest interval long or upon return of spontaneous circulation after prolonged resuscitation.
Standing Orders
1. If the patient is making efforts to clear the airway without success, you may assist with careful back blows (infants only), chest or gentle abdominal compressions (per BCLS Protocols) - avoid abdominal compressions in infants less than one year old. Synchronize with patient's cough.
2. If the patient has lost consciousness, attempt to open the airway (use moderate extension and jaw-lift) and ventilate. Reposition and attempt ventilation again if necessary. If unsuccessful, perform standard obstructed airway maneuvers for infant, child or adult, as appropriate. Position an infant with the head dependent during back blows and chest compressions.
3. Consider direct laryngoscopy and foreign body removal with Magill forceps.
4. If unable to remove by any method, attempt to blow obstruction past the trachea with mouth-to-mask ventilation. Attempt endotracheal intubationf authorized.
5. Transport early. Contact a medical control physician promptly for further orders if necessary.
Standing Orders
1. Keep patient upright at all times when conscious.
2. Begin oxygen therapy. Remove mask if not well tolerated.
3. If child is unconscious, position supine and begin ventilation.
4. Place ECG leads.
5. Transport early.
6. Contact a medical control physician as soon as possible if epiglottitis is suspected or distress is marked.
7. Consider nebulized epinephrinefor suspected croup.
a. Recommend dosage of 5 mg 1:1000 (5cc) or as specified by service medical director.
8. If unable to neb, may give epinephrine0.01 mg/kg 1:1000 SC.