Suggested emergency protocol for students with asthma symptoms who don't have a personal asthma action plan

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):
• 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

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.
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.
a. Respirations and pulse (Normal rates listed on back. Report to MD or EMS). b. 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.
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. Normal Breathing and Pulse Rates by Age (from EPR-2)
Breathing Rate
Pulse Rate

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


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