If you are a first-responder in a pediatric asthma emergency, the following may be appropriate actions. Consult the emergency medicine team at the receiving hospital for further direction:
- Out-of-hospital treatment of asthma emergencies includes the use of bronchodilators and intramuscular (IM) epinephrine.
- Nebulized albuterol (2.5mg/3ml), an inhaled beta-2 agonist, may be initiated with or without ipratropium bromide (0.25-0.5mg), an inhaled anticholinergic, depending on agency-specific protocols.
- Additional doses of albuterol may be administered, but ipratropium bromide is recommended for a max of 3 doses.
- IM epinephrine (0.01mg/kg of 1 mg/ml concentration, 0.3ml max) may be warranted if a child is not tolerating nebulized treatments, or if bronchodilators are ineffective due to poor air movement with breathing.
Remember, asthma exacerbations create an air-trapping effect associated with severe bronchospasm. Assisted ventilation may be necessary in instances of respiratory failure, but may also be associated with complications and death.
If a child fails to respond to aggressive bronchodilator and high-flow oxygen therapy, consider assisting ventilation with slow rates and long expiratory times to minimize barotrauma and allow for exhalation of carbon dioxide.