ER - asthma

Question 1

Signs that the asthma exacerbation is mild? (3)

Answer 1

1. normal vital signs (including sats > 90%)
2. mild wheezes
3. minimal work of breathing

Question 2

Signs that the asthma exacerbation is moderate? (3)

Answer 2

1. elevated HR and RR (but sats > 90%)
2. wheezing
3. increased work of breathing

Question 3

Signs that the asthma exacerbation is severe? (4)

Answer 3

1. abnormal vital signs including sats < 90%
2. significantly increased work of breathing
3. altered mentation
4. wheeze can be ABSENT

Question 4

Acute asthma exacerbation goals of treatment (3)

Answer 4

1. Correct hypoxemia
2. Rapid reversal of airflow obstruction
3. Reduction of the likelihood of relapse

Question 5

Treatment for mild to moderate asthma exacerbation?

What else do you think about giving if severe?

What else do you think about doing if severe?

Answer 5

1. inhaled SABAs and ipratropium and steroids
2. severe, consider IV magnesium
3. super severe, consider NIPPV or intubation

Question 6

Ventolin route, dose and frequency for asthma exacerbation?

Bonus: Dose if continuous?

Answer 6

Route: MDI or nebulized

Dose: 2.5-5 mg q20minutes for up to 3 doses, followed by 2.5-10 mg every 1-4 hours as needed

Dose of “continuous” albuterol neb is 10-15 mg/hr (0.5 mg/kg/hr in children)

Question 7

Atrovent route, dose and frequency for asthma exacerbation?

Answer 7

ipatropium, SAMA, ie anticholinergic

Route: MDI or neb

Dose: 500 microgram (or 2.5 mL) q20 minutes up to 3 doses, followed by 2.5 mL every 6 hours as needed.

There is no apparent benefit beyond 3 back-to-back treatments.
Combining ipratropium with SABAs provides an advantage over using it as a single agent

Question 8

Mag sulfate in asthma exacerbation
Indication? Dose? Route?

Bonus: MOA?

Answer 8

MgSO4 give 2 g IV over 20 minutes, suggested for patients who present with a life-threatening exacerbation or have a severe exacerbation that is not responding to initial therapy

MOA - relaxes smooth muscle in airways

Question 9

What might you give if you suspect anaphylaxis manifest as an asthma exacerbation?
dose?

Answer 9

Epinephrine 0.3-0.5 mg IM q30min up to 3x

Pediatric dose 0.01 mg/kg IM q30min up to 3x (up to 0.3-0.5 mg)

Question 10

Steroid in asthma exacerbation?
Always - yes or no?
Dose for peds?
Route?
How many doses?

Answer 10

Essential component of therapy, give early (within first hour)!

• give dex 0.6 mg/kg PO daily x2d for asthma exacerbations managed in the ED
• IV/IM options but generally try to give PO just because less invasive

Dexamethasone can be administered once in the ED and once in the next 1-2 days with equivalent effect to a 3-5 day burst of prednisone.