respiratory Distress

Albuterol/Atrovent doubles once or 3

Improvement

Complete improvement

Parial Improvement

inhalers

Albuterol/Atrovent doubles X 3

Albuterol continuous 10, 15 or 20

less than 1 hr

well for more than 1 hr off

to Floor

Albuterol/Atrovent single or double starting at q2/q1spaced to q4/q2 then q 6/q4

Improvment

Orapred 5 d

Consider adjusting the albuterol

MDI spacer

Nebulizer

consider adding inhaer steroids

Flovent

Pulmicort

Consider adding steroids/long acting beta

Advir

strength 100

Strength 250

Strength 500

Consider Singulair

Consider referring for allergy

No improvment

Chest PT, Spirometer

Repeat CXR

Consider Abx for atypical pneumonia

Atelectasis

relapse less than one hour off

more than 1 hr

to ICU

Continue Albuterol continues

Steroids

Orapred

IV Solumedrol

For URI symptoms

CXR

Respiratory screen

If +

No Improvement, but the child looks comfortabe

supportive tx: O2 ; suctioning

occasinally racemic epi

typical

Racemic epi and Dexa one dose; O2; suctioning

wheezing component

Improved

Humidified air

stress at rest

ICU

Heliax

Dexa

Intubation?

atypical

chest CT

Bronchoscopy

CTA