Asthma Pearls from Dr Stinar (peds) and Dr Morrow

Pearls in Asthma Management:

  • 4 puffs albuterol = 2.5 mg
  • 8 puffs albuterol = 5 mg
  • Prednisone and dexamethasone are equivalent, and there is peds ER literature re: prednisone keeping kids out of the hospital.
  • Generally, don’t start asthma kids with 2.5mg dosing  – go big – go 5mg.
  • You’re never going to kill a kid with albuterol.  Not even the hypoK is an issue.
  • If a parent has asthma, 50/50 chance the kid will have asthma.
  • Other associations:  eczema, food or environmental allergies – ask about them.

Slide set from Asthma (in less than 10 slides) by Dr Becky Morrow (PGY-3), FMTS presentation:

pediatric-asthma

ER Management of Asthma Exacerbation:

  • O2 for SaO2 < 90%
  • Ipratropium and albuterol x 3
    • < 20 kg weight – 2.5 mg
    • > 20 kg weight – 5 mg
  • Dexamethasone 0.6 mg/kg x 2 days OR prednisone 2mg/kg in 2 doses x 3-5 days
    • Dexamethasone IV solution can be used orally!
  • Continuous neb and recheck in 1 hour
    • < 20kg – 7.5 mg/hr
    • > 20kg – 10 mg/hr
  • Consider: admission, IV MgSO4, NIPPV, ABG, CXR, transfer

Discharge Criteria from ED:

  • PAS score < 7
  • SaO2 > 90% on RA
  • Continue bronchodilators q 4 hours x 3 days or until f/u or PO steroids finished
  • Rx ICS if h/o prior ED visit
  • Asthma education and action plan in place
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