Pediatric Respiratory Emergencies Algorithm

Last updated: December 20, 2020

2020 updated guidelines have been published by American Heart Association®, by enrolling in our courses you will receive our ACLS & BLS courses that follow 2020 American Heart Association® Guidelines for CPR and ECC, PALS course follows 2016 AHA Guidelines for CPR & ECC. Please note that our company typically implements new training guidelines up to a year before AHA releases their updates.

After careful assessment, always begin with the basics. Any infant or child with respiratory distress should first receive the following whenever they are doable or accessible

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  • Positioning to make breathing as easy as possible. Allow an older child to assume a position of comfort.
  • Suction if needed
  • Pulse oximetry and oxygen if indicated by pulse ox of less than 94% or if the patient is short of breath
  • ECG monitor
  • Basic Life Support maneuvers as indicated by condition

Treatment of respiratory emergencies depends upon the origin within the respiratory system. This can be divided into four categories, each one having its own interventions.

Upper airway obstruction

  • CROUP
    • Nebulized epinephrine
    • Steroids
  • ANAPHYLAXIS
    • IM epinephrine or EpiPen®
    • Albuterol
    • Antihistamines
    • Steroids
  • FOREIGN BODY ASPIRATION
    • Support airway
    • Expert consultation

Lower airway obstruction

  • ASTHMA
    • Albuterol with or without ipratropium
    • Steroids
    • Subcutaneous epinephrine
    • Magnesium sulfate
    • Terbutaline
  • BRONCHIOLITIS
    • Nasal suctioning
    • Bronchodilator

Lung tissue disease

  • PULMONARY EDEMA
    • Consider ventilation support with PEEP
    • Support blood pressure with vasoactive drugs
    • Consider diuretic
  • PNEUMONIA
    • Albuterol
    • Antibiotics as indicated by condition
    • Consider CPAP

Disordered control of breathing

  • POISONING OR OVERDOSE
    • Specific antidote from Poison Control
  • NEUROMUSCULAR DISEASE
    • Ventilation support as dictated by condition
  • HEAD INJURY – INCREASED INTRACRANIAL PRESSURE
    • Avoid hypoxemia
    • Avoid hypercarbia
    • Avoid hyperthermia
This page is written by on Mar 30, 2017.
This page is last reviewed and updated by on Jun 4, 2020.