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:
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