Asthma

Question 1

Pt meeting criteria for this protocol

Answer 1

Known asthmatic or pt w/ continued wheezing after Tx.

Question 2

Pertinent Hx

Answer 2

• Intubation
• PICU admission
• Recent steroid/HHN/MDI use

Question 3

Asthma Assessment

Answer 3

• Airway
• Breath sounds
• WOB
• Position of comfort
• IV access
• Give 20ml/kg NS bolus if DBP <35 in preschooler or <40 in school age child
• Give Albuterol as continuous if multiple intermittent doses have already been given, or if pt already on continuous)

Question 4

Continuous Albuterol HHN Dosage

Answer 4

0.5 mg/kg/hr rounded up to nearest 5 mg

Max dose 20mg/hr

Question 5

Atrovent HHN Dosage

Answer 5

<12 y/o: 0.25mg q20 min prn, up to 3 doses
>12 y/o: 0.5 mg q30 min prn, up to 3 doses
-may give together with albuterol

Question 6

Solu-Medrol IV dosage

Answer 6

1 mg/kg
Max dose 60 mg
*Do not give if oral steroids have been given and retained
-May substitute Decadron 0.6 mg/kg IV/PO (Max dose 16 mg)

Question 7

Response to Tx

Answer 7

Good:
-Decreased WOB
-Increased aeration on inspiration
-Continue O2 to keep SpO2 >92%
-If pt later worsens, proceed to poor response
Poor:
-Minimal/no improvement
-Decreased aeration
-Continuous albuterol
-Mag Sulfate 50 mg/kg IV over 20 min (Max 2g/dose)
*Beware of hypotension

Question 8

Xopenex

Answer 8

• May be substituted if pt already on medication or severly tachycardic
• Dosage: <12 y/o 0.63 mg, >12 y/o 1.25 mg

Question 9

Continued poor response after interventions

Answer 9

Contact medical control for:

• Epinephrine (1:1000) IM or SQ 0.01 mg/kg (Max 0.4mg) may repeat q10-20 min, up to 3 doses.
• Terbutaline SQ: <12 y/o 0.005 mg/kg q15-20 min x3 doses (Max 0.4 mg/dose), >12 y/o 0.25 mg q15-20 min x3 doses.
• Terbutaline IV (continuous infusion): Loading dose 10 mcg/kg followed by 0.1 mcg/kg/min titrate per order (*monitor BP q5 min)
• Aditional Mag Sulfate
• Obtain blood gas
• Consider BiPAP before intubation, use NIPPV protocol
• *Consider Ketamine 1 mg/kg IV as sedative for Intubation