Version control: This document is current with respect to the latest 2016 American Heart Association® Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 21, 2020. If you are reading this page after October 21, 2020, please contact ACLS Training Center at for an updated document.

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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

  • 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