First 5 minutes stabilization
›Immediate priorities
›Minimal agitation strategy
›Upright positioning
›Continuous monitoring
›Two large bore IV if moderate to severe distress
›Oxygen and ventilation
›Blow by oxygen for children
›Non rebreather for older children and adults
›High flow nasal cannula if worsening distress and tolerated
›Airway escalation triggers
›If persistent stridor at rest with hypoxia, airway team activation
›If decreasing mental status, prepare for controlled intubation
›Croup suspected
›Dexamethasone PO or IM 0.6 mg per kg
›Maximum 10 mg
›Nebulized epinephrine racemic 2.25 percent 0.5 mL in 3 mL saline
›Alternative L epinephrine 1 mg per mL 5 mL nebulized
›Anaphylaxis suspected
›Epinephrine IM 0.3 mg to 0.5 mg of 1 mg per mL adult
›Repeat every 5 to 15 minutes if needed
›Epinephrine IM 0.01 mg per kg pediatric
›Maximum 0.3 mg prepubertal
›Maximum 0.5 mg adolescent
›Diphenhydramine IV or PO 25 mg to 50 mg adult
›Cetirizine PO 10 mg adult if able to swallow
›Methylprednisolone IV 125 mg adult
›Albuterol nebulized for bronchospasm
›IV crystalloid bolus 20 mL per kg pediatric
›IV crystalloid bolus 1 L adult
›Angioedema suspected
›Histamine mediated pathway if urticaria present
›Epinephrine IM dosing per anaphylaxis pathway
›H1 antihistamine dosing per anaphylaxis pathway
›Steroid dosing per anaphylaxis pathway
›Bradykinin mediated angioedema local protocol dependent therapies
›Early airway planning if tongue or floor of mouth swelling
›Post extubation stridor suspected
›Nebulized epinephrine as above
›Dexamethasone IV 10 mg adult
›Pediatric dexamethasone 0.6 mg per kg
›Airway plan
›Difficult airway setup
›Backup plan
›Surgical airway readiness if cannot intubate cannot oxygenate
›Intubation approach
›Prefer experienced operator
›Video laryngoscopy first line when available
›Smallest appropriate endotracheal tube if subglottic edema
›Induction and paralysis examples
›Ketamine IV 1 mg per kg to 2 mg per kg
›Etomidate IV 0.3 mg per kg
›Rocuronium IV 1.2 mg per kg
›Succinylcholine IV 1.5 mg per kg if no contraindication