FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Wheezing, asthma/COPD with decreased breath sounds and labored breathing, symptomatic smoke inhalation, or the specified crush-injury pathway. Use the matching adult or pediatric standing order.
Contraindications & local exclusions
- The cited inhalation-solution label excludes hypersensitivity to any component. Do not substitute an inhaler, nebulized solution, or concentration without checking the corresponding instructions.
Precautions
- Watch for paradoxical bronchospasm, tachycardia and cardiovascular effects; reassess breathing and response. Stop the preparation if paradoxical bronchospasm occurs.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- Anaphylaxis requires epinephrine; albuterol is an adjunct for bronchospasm.
- If pediatric respiratory status worsens or treatment fails, contact base; a pediatric-capable base is preferred.
Use in OCEMS
- Used for wheezing/bronchospasm, including asthma or COPD, and selected smoke-inhalation and crush-injury pathways.
- Persistent severe bronchospasm may require additional base-directed treatment; bronchodilator delivery does not replace ventilatory support.
Adult / adolescent
| Indication / route | Dose & limits |
|---|---|
| Nebulized solution | 5 mg in 6 mL by continuous nebulization, as tolerated, under the relevant standing order. |
| Metered-dose inhaler listed in I-15 | 90 mcg per actuation: 2 puffs every 2 hours until symptoms resolve. Check that the applicable MDI procedure and agency authorization apply. |
Pediatric
- SO-P-035 specifies 5 mg in 6 mL by continuous nebulization for wheezing/suspected asthma. SO-P-060 also uses this regimen for anaphylaxis with wheeze or hypoxia.
- I-20 lists 2.5 mg in the 3–5 kg newborn band. This differs from the general pediatric respiratory standing-order wording: reconcile the neonatal dose with base rather than treating the table and condition order as interchangeable.
Pediatric dose by age / weight
- SO-P-035 / SO-P-060: continuous nebulization for the specified wheezing/respiratory indication. Weight does not independently establish treatment eligibility.
| Weight / use | Pediatric dose | Volume / route |
|---|---|---|
| 3–5 kg newborn band | Resolve the dosing difference with base | I-20: 2.5 mg / 3 mL; general SO-P-035: 5 mg / 6 mL |
| Other eligible pediatric patients | 5 mg | 6 mL by continuous nebulization as tolerated |
Preparation & reassessment
- Nebulizer stock is commonly 2.5 mg/3 mL; confirm the total medication and volume.
- Reassess air movement, work of breathing, oxygenation, and heart rate. Consider CPAP only when its separate age and clinical criteria are satisfied.
UNDERSTAND THE CARE
Why aerosol delivery is not the same as adequate ventilation
Albuterol is used in specified bronchospasm pathways, but a running nebulizer does not prove that the patient is moving air adequately. Document effort, air movement, oxygenation and heart rate before and after treatment. In anaphylaxis it is an adjunct and should not replace initial epinephrine.
Applying the guidance
Check the total drug and solution volume rather than counting containers without reading them. Pediatric respiratory standing-order wording and the newborn I-20 band differ; make that discrepancy explicit and obtain reconciliation rather than silently substituting one for the other. CPAP has separate patient, age, device and pressure requirements even when aerosol treatment is considered.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Clinical pattern
- Bronchospasm and adequate ventilatory effort.
- Preparation
- Total medication, solution and delivery setup.
- Age-specific limits
- Resolve the newborn chart/order difference.
- Response
- Air movement, effort, oxygenation and tolerance.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-M-035 — Respiratory Distress
- SO-P-035 — Acute Respiratory Distress - Pediatric
- SO-P-060 — Allergic Reaction / Anaphylaxis - Pediatric
- PR-900 — State of Emergency - Use of Spacer-Metered Dose Inhaler in Place of Nebulizer for Administration of Albuterol
- Product label — ALBUTEROL SULFATE solution
- Name / formulation reference — Medication name and formulation terminology
Resolve a dose conflict before counting containers
The newborn row is intentionally an unresolved source difference: I-20 and the general pediatric respiratory order do not give the same amount for that band. Reading both sources is more useful than silently choosing whichever table is closest. Tell base the patient’s age/weight, clinical presentation, the two source entries and what has already been administered so the direction can be specific.
For any nebulizer setup, distinguish the total drug amount from the total solution volume and the number of containers used. Those are related measurements, but the count of vials alone does not identify the administered dose. Record the preparation actually used and the patient’s tolerance and respiratory response.
In a teaching scenario where a nebulizer is running but respiratory status worsens, reassess the patient and support needs rather than assuming that delivery of aerosol has completed treatment. The pediatric order requires base contact for nonresponse or worsening, and Policy 310.00 has additional pediatric respiratory-distress contact criteria. The emergency MDI substitution document also retains its own authorization context.