normal mental state and minimal if any recession or use of accessory muscles
able to talk normally
Mx in ED
inhaled salbutamol one dose and review 20 min later
6 puffs if < 6 years old, 12 puffs if >6 years old
oral prednisolone (1 mg/kg daily for 1-3 days) if on prophylaxis or episode has persisted over several days.
CXR or pathology tests not usually indicated
inadequate response, Mx as for moderate asthma
adequate response, discharge home with asthma discharge plan
consider advising preventive treatment if there are frequent acute episodes or chronic symptoms (more than one disturbed night per week, difficulty participating in physical activities, or bronchodilator use on more than one day per week).
moderate asthma
SaO2 92-95% in room air on arrival to ED
normal mental state and some recession or use of accessory muscles
some limitation of ability to talk normally
tachycardia
Mx in ED
inhaled salbutamol by MDI/spacer - 1 dose (as above) every 20 minutes for 1 hour ;
oral prednisolone (1 mg/kg daily for 3 days)
give oxygen if SaO2 falls below 92% (this is common after salbutamol Rx due to V/Q mismatch)
CXR or pathology tests not usually indicated
review 10-20 min after 3rd dose of salbutamol to decide on admission or discharge.
if discharge planned:
should not leave ED until at least one hour after their last nebuliser and final review.
asthma discharge plan
consider advising preventive treatment if there are frequent acute episodes or chronic symptoms (more than one disturbed night per week, difficulty participating in physical activities, or bronchodilator use on more than one day per week).
severe asthma
SaO2 < 92% in room air
agitated/distressed
moderate-marked use of accessory muscles / recession
tachycardia
marked limitation of ability to talk
Mx in ED
oxygen
inhaled salbutamol by MDI/spacer: 1 dose (as above) every 20 minutes for 1 hour