Asthma

RAD Exacerbation/ Status Asthmaticus

Upon presentation to the ED

1. Beta 2 agonist
- Albuterol 0.5-1.0 ml 3 back to back as
needed with atrovent
- formulation 5mg/ml
- Atrovent (1 unit dose= 2.5 ml= 500 mcg) anti-cholinergic, studies shown only useful in first 24 hours.
- side effects- tremor, tachycardia, hypokalemia, heart rhythm disturbance

2. Give steroids upon presentation at 2 mg/kg for the first dose then 1mg/kg for
3-5 days total Prednisone (tablets) or Orapred (15mg/5ml) PO

3. Option to give Decadron 0.6 mg/kg max 10 mg if unable to take prednisone PO
- If not tolerating PO or in significant respiratory distress give Solumedrol
- Dose: Loading Dose 2 mg/kg/dose x 1
- Maintenance 2 mg/kg/24 hr div q 6hr. 125 mg in adults q 6hr

4. Oxygen to keep O2 sats >=92%

Reassess Frequently
- check VS and peak flows
- If clear and no resp distress(judge with attending) home on PO steroids for 3-
5 days total.

If poor response to nebs and require admission(work of breathing or sat<94%)
then:
- if able to space to q 90 min may admit to floor
- if not then admit to PICU

Magnesium Sulfate 40 mg/kg(max 2 grams) IV over approx 30 minutes
- side effects: hypotension, seizures, muscle weakness, pain
- caution if patient with renal problems

Terbutaline IV/IM load
- bolus 10 mcg/kg over 10 min
- drip start at 1.0 mcg/kg/min
- may increase/decrease by 1 mcg/kg/min as needed q 15 min max 10 mcg/k/min
- titrate to effect keeping HR<200 under 1 y/o, and HR<175 above 1 y/o

Epinephrine
- May give epinephrine(1/1000)- 0.01 ml/kg(max 0.3ml) q20min for up to 3 doses

Worst case:
- Intubation (consider Ketamine for sedation) and ICU