OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• paediatric emergency medicine
• asthma
• Mx of critically severe paediatric asthma
• asthma science

• RCH - asthma (pdf)
• RCH - use of spacers (pdf)
• Vic DHS - paediatric asthma (pdf)

• SaO2 > 95% in room air on arrival to ED
• normal mental state and minimal if any recession or use of accessory muscles
• able to talk normally

• 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).

• 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

• 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).

• SaO2 < 92% in room air
• agitated/distressed
• moderate-marked use of accessory muscles / recession
• tachycardia
• marked limitation of ability to talk

• oxygen
• inhaled salbutamol by MDI/spacer: 1 dose (as above) every 20 minutes for 1 hour
• ipratropium by MDI/spacer
  • < 6 years old: (Atrovent 20mcg/puff) 4 puffs then 2 puffs q6h
  • > 6 years old: (Atrovent 20mcg/puff) 8 puffs¹⁾ then 4 puffs q6h
• oral prednisolone (1 mg/kg daily)
  • if vomiting give i.v. methylprednisolone 1mg/kg instead
• review on-going requirements 10-20 min after 3rd dose
• if improving reduce frequency, if no change continue 20 minutely, if deteriorating at any stage treat as critical
• involve senior staff
• CXR or pathology tests not usually indicated
• arrange admission after initial assessment if suitable for admission in your hospital

• confusion / drowsiness
• maximal accessory muscle use / recession
• exhaustion
• SaO2 < 90% in air
• marked tachycardia (a sign of hypercapnia, hypoxia or perhaps salbutamol Rx)
• unable to talk
• requiring continuous salbutamol Rx for > 1 hour
• requiring salbutamol more frequently than 30min for more than 2 hours

• see Mx of critically severe paediatric asthma

• RCH guideline - acute asthma
• NSW NETS - asthma (pdf)