FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- IM asthma epinephrine requires the base-order pathway; anaphylaxis has its own standing-order criteria.
- Do not use pediatric CPAP below age 8 or above the pediatric pressure limit.
First assessment
- Assess appearance, work of breathing, and circulation, then support the airway and ventilation as needed.
- When SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.
- Check for an allergic trigger, upper-airway obstruction, wheeze, barking cough, and poor perfusion.
Wheeze or anaphylaxis
- For suspected asthma with wheeze: albuterol 5 mg in 6 mL by continuous nebulization as tolerated. If there is no improvement, consider a base-order request for IM epinephrine.
- For possible anaphylaxis with upper-airway obstruction or respiratory distress: epinephrine 0.01 mg/kg IM of the 1 mg/mL preparation, maximum 0.5 mg, and the fuller SO-P-060 pathway.
- CPAP requires an appropriate mask and the separate PR-120 criteria; the current procedure applies from age 8, with pediatric pressure no higher than 5 cm H₂O.
Croup-like cough & perfusion
- For recurrent barking-type cough, give 3 mL normal saline by continuous nebulization as tolerated.
- With poor perfusion, obtain IV/IO and give 20 mL/kg saline, maximum 250 mL, with base contact. May repeat twice for 3 total boluses.
Reassess & escalate
- Use ALS escort to the nearest appropriate ERC. Contact base, pediatric-capable preferred, if there is no response or status worsens.
- 310.00 also includes pediatric respiratory distress as a base-contact trigger. Record the child’s weight, respiratory findings, treatment, and response.
- The I-20 newborn band lists a different albuterol amount from the general respiratory-order wording. Reconcile neonatal dosing with base rather than silently substituting a chart row.
VISUAL FIELD REFERENCE
Wheeze, anaphylaxis, or barking cough?
Pediatric · ALS
Match the presentation to its pathway. Continue oxygenation, ventilation, and perfusion assessment.
Wheeze / suspected asthma
For suspected asthma with wheeze: albuterol 5 mg in 6 mL by continuous nebulization as tolerated. If there is no improvement, consider a base-order request for IM epinephrine.
Possible anaphylaxis
For possible anaphylaxis with upper-airway obstruction or respiratory distress: epinephrine 0.01 mg/kg IM of the 1 mg/mL preparation, maximum 0.5 mg, and the fuller SO-P-060 pathway.
Recurrent barking-type cough
For recurrent barking-type cough, give 3 mL normal saline by continuous nebulization as tolerated.
- Assess appearance, work of breathing, and circulation, then support the airway and ventilation as needed.
- Use ALS escort to the nearest appropriate ERC. Contact base, pediatric-capable preferred, if there is no response or status worsens.
- The I-20 newborn band lists a different albuterol amount from the general respiratory-order wording. Reconcile neonatal dosing with base rather than silently substituting a chart row.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-P-035 · PR-120 · SO-P-060 · 310.00 · I-20
UNDERSTAND THE CARE
Why the respiratory sound must be placed in context
Wheeze, a barking cough and signs of an allergic airway problem lead to different local branches. Observe air movement, effort, mental status and perfusion together and do not let a single sound determine the entire assessment. The child’s weight and age also affect which treatment instructions and devices fit.
Applying the guidance
Reassess the response to oxygen, airway support and the selected treatment. Continued or worsening distress calls for escalation and base involvement. IM epinephrine for the asthma branch requires the base-order pathway, whereas anaphylaxis has its own standing-order criteria. The newborn albuterol chart difference should be reconciled with base, not silently resolved by choosing whichever number is familiar.
Putting it together
Teaching example: a child with wheeze develops reduced interaction and diminishing breathing effort. Reassess ventilation and perfusion and communicate deterioration rather than judging success only by the sound becoming quieter.
Diagram text & teaching checkpoints
- Pattern
- Wheeze, barking cough or allergic features.
- Physiology
- Effort, air movement, interaction and perfusion.
- Eligibility
- Age, weight, device and order requirements.
- Response
- Reassess and involve pediatric-capable base.
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.