PED-Breathing Difficulty

Pediatric Stridor


  • Keep the patient calm
  • Consider 0.9% NaCl mist via nebulizer
  • Place patient on a cardiac monitor
  • Contact medical control if considering nebulized epinephrine
  • Epinephrine 0.5 ml of 1:1000 solution mixed in 2.5 ml of 0.9% NaCl, nebulized
  • Continue nebulized 0.9% NaCl afterwards may be beneficial

Pediatric Respiratory Distress (Wheezing or Asthma)


  • Assess need for assisted ventilation
  • Allow patient to sit in a position of comfort
  • If wheezing, albuterol 0.5 ml in 2.5 ml 0.9% NaCl nebulized
  • Initiate transport
  • May give 3 albuterol nebulized treatments. May considering adding 1 vial Ipratropium Bromide (0.5% of 0.02%) to the albuterol treatments, or substituting Duoneb.  Contact medical control if additional treatments needed
  • For severe respiratory distress, contact medical control while BVM ventilating. For impending respiratory failure, contact medical control for consideration of epinephrine 1:1000 IM 0.01 ml/kg (max 0.3 ml)
  • For patients ages 3-16 y.o. who are awake, oriented, can take oral medications, have known asthma or reactive airway disease, or history of multiple episodes of wheezing responsive to albuterol, and are NOT currently taking steroids, have a history of cancer, diabetes, or immune deficiency, administer one of the following:

Prednisolone 3 mg/ml liquid

  • Age 3-7 years: 30 mg (10 ml)
  • Age 8-16 years: 60 mg (20 ml)

Prednisone 20 mg tablets

  • Age 3-7 years: 30 mg (1.5 tabs)
  • Age 8-16 years:  60 mg (3 tabs)

Solumedrol IV solution to be administered PO (125 mg/2ml)

  • Age 3-7 years: 30 mg (0.5 ml)
  • Age 8-16 years: 60 mg (1 ml)

Pediatric Respiratory Distress (Obstruction or FBO)


Alert and not choking

    • Begin transport with patient as comfortable as possible
    • If wheezing, albuterol nebulized treatment

Alert and choking

  • <1 y.o., give 5 back slaps and 5 chest thrusts; repeat as necessary
  • >1 y.o., give abdominal thrusts (Heimlich maneuver)
  • Unconscious
  • Begin CPR/BVM
  • With laryngoscope, look for foreign body and remove with Magill forceps
  • If no foreign body, intubate
  • If still no chest rise, consider pushing tube in right mainstem or needle cric
  • Contact medical command and transport to the closest appropriate facility

Breathing Difficulty – PED