Suggested Emergency Protocol For Students With Asthma Symptoms Who Don't Have A Personal Asthma Action Plan

Supplies:

Albuterol inhaler, spacer/holding chamber, peak flow meter, chart of predicted peak flow values, oxygen (if available)

Possible observations/symptoms (May include one or more of the following):

• Coughing
• Wheezing, noisy breathing, whistling in the chest,
• Difficult breathing, tightness in chest, shortness of breath or chest pain, breathing hard and/or fast, discomfort when breathing,
• Nasal flaring (nostril opens wide to get in more air)
• Can only speak in short sentences or not able to speak
• Blueness around the lips or fingernails

Actions:

1. Restrict physical activity and allow student to rest. Encourage student to breathe slowly and relax.
   
   
2. Place the student in an area where he/she can be closely observed. Never send a student to the health room alone or leave a student alone. Limit moving a student who is in severe distress. Go to the student, instead.
   
   
3. Quickly evaluate the student.
   
   
4. Check and record:
   • Respirations and pulse (Normal rates listed on back. Report to MD or EMS).
   • Peak flow meter reading. (If personal best is unknown, use prediction chart.)
     CALL 911 if peak flow is less than 50% of personal or predicted best.
     
     
5. Administer albuterol--2 puffs albuterol, 5-10 seconds between puffs. Medication must be authorized by a personal physician order or a standing protocol signed by a school physician or public health physician. School nurses (or designee if authorized and appropriate) may administer albuterol from school supply, if available, and student does not have a personal albuterol inhaler. Use a spacer/holding chamber and disposable mouthpiece.
   
   
6. Contact parents (even if situation does not appear severe).
   
   
7. Re-evaluate student after 10-15 minutes. Check for ease of breathing, peak flow, pulse and respirations.
   • If student is improving, keep the student in the health room under supervision until breathing returns to normal. Follow school protocol for returning to class.
   • If student is not improving, contact student's physician or call 911. Administer albuterol again--2 puffs, 5-10 seconds between puffs. May repeat for up to 3 treatments.
     
     
8. With parental permission, provide report of health room encounter to student's physician.
   
   
9. Obtain a personal asthma action plan for this student from the student's family or physician.

Peak Flow predicted best chart (add chart for type of meter used)

Developed July 2005.