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:
- Restrict physical activity and allow student to rest. Encourage student to breathe slowly and relax.
- 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.
- Quickly evaluate the student.
- 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.
- 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.
- Contact parents (even if situation does not appear severe).
- 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.
- With parental permission, provide report of health room encounter to student's physician.
- Obtain a personal asthma action plan for this student from the student's family or physician.
Call 911 and immediately administer albuterol
and O2 (if available) if in severe distress!
(For example: unable to speak, lips blue,
or peak flow <50% personal or predicted best).
Contact parent/guardian.
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Normal Breathing and Pulse Rates by Age (from EPR-2)
Age | Breathing Rate | Pulse Rate |
<2 months | <60/minute | <160/minute |
2-12 months | <50/minute | <120/minute |
1-5 years | <40/minute | <110/minute |
6-8 years | <30/minute | <110/minute |
9-15 years | <30/minute | <100/minute |
16-18 years | <20/minute | <90/minute |
Peak Flow predicted best chart (add chart for type of meter used)
Developed July 2005.
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