Annotations Episode Severity

Episode Severity

 

Episode Severity

 

Mild

Moderate

Severe

Beta-agonists

Give albuterol three times within 60 minutes for ages 2 to 17 years

Probably do it

Probably do it

Do it

Route of delivery

MDI with spacer
Probably do it

MDI with spacer
Probably do it

Nebulizer
Do it

continuous nebulization in non-intubated patients


 

Probably do it

intravenous vs. continuously-nebulized beta-agonists

 

 

Don't do it

 

Mild

Moderate

Severe

Corticosteroids

Systemic corticosteroids within 1 hour of arrival

Do it

Do it

Do it

Route of administration

Oral route
Probably do it

Oral route
Probably do it

Intravenous route
Probably do it

Addition of inhaled corticosteroid to systemic corticosteroids

Probably don't do it

Probably don't do it

Probably don't do it

Administration of an inhaled corticosteroid in place of a systemic corticosteroid

Probably don't do it

Probably don't do it

Probably don't do it

Ipratropium

Mild

Moderate

Severe

 

Addition of ipratropium to inhaled beta-agonists for ages 2-17 years

Probably don't do it

Probably do it

Probably do it

The addition of ipratropium to inhaled beta-agonists for patients less than 2 years old

Probably don't do it

Probably don't do it

Probably don't do it

Oxygen

Mild

Moderate

Severe

There are two ways to determine whether oxygen should be administered: Both ways are presented here.

Option 1: based on episode severity (D)

Don't do it

Probably do it

Administration of oxygen to a patient with a severe episode of asthma can cause respiratory failure. Therefore, it is critical to monitor pulse oximetry continuously while oxygen is being administered.

Do it

Option 2: based on oxygen saturation (D)

O2 saturation >95%

Don't do it

O2 saturation 90-94%

Probably do it

O2 saturation <90%

Do it

 

Mild

Moderate

Severe

Administration of IV fluids (assuming the patient is not vomiting or clinically dehydrated)

Don't do it

Suggested not (<40%)

Don't do it

Amount of fluids (if not clinically dehydrated)

< Maintenance

Probably do it

Maintenance fluids

Optional (no threshold)

> Maintenance

Optional (no threshold)

Antibiotics

Antibiotics should not be given to children with acute asthma unless they have evidence of a bacterial infection

Don't do it

Don't do it

Don't do it

Intravenous Aminophylline

When initially presenting for treatment

Don't do it

Don't do it

Don't do it

After two hours of continuous nebulized albuterol, with suboptimal response

 

 

Probably do it

Salmeterol

2 sprays every 12 hours to inpatients via Aerochamber & mask

Probably do it

Probably do it

Probably do it

Magnesium Sulfate
(intravenous use)

Some studies showed improved peak flow for severe patients, but no significant differences in admissions.

Don't do it

Don't do it

Don't do it

Heliox

Don't do it

Don't do it

Don't do it

Subcutaneous Epinephrine

Don't do it

Don't do it

Don't do it

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