Asthma

Question 1

What is the inpatient treatment for Mild Asthma Exacerbation? (3)

Answer 1

1. oxygen for saturation > 90%
2. Dexamethasone 0.6 mg/kg PO x1 dose OR
   
   • Prednisone/Prednisolone PO 2 mg/kg/day x3-5 days
3. Albuterol (MDI with spacer)
   
   • < 20 kg = 2 puffs
   • > 20 kg = 4 puffs

Question 2

What is the inpatient treatment for Moderate Asthma Exacerbation? (4)

Answer 2

1. oxygen > 90%
2. Dexamethasone 0.6 mg/kg PO x1 dose OR
   
   • Prednisone/Prednisolone PO 2 mg/kg/day x3-5 days
3. Albuterol (MDI with spacer) OR
   
   • < 20 kg = 4 puffs
   • > 20 kg = 8 puffs
4. Continuous Albuterol (nebulized)
   
   • < 20 kg = 10 mg/hr
   • > 20 kg = 15 mg/hr
5. Magnesium Sulfate IV
   
   • 50 mg/kg (max: 2 grams)

Question 3

What is the inpatient treatment for Severe Asthma Exacerbation? (5)

Answer 3

1. oxygen > 90%
2. Methylprednisolone IV
   
   • 2 mg/kg/day q24 or divided q12 (max: 60 mg/day)
3. Continuous Albuterol (nebulized)
   
   • < 20 kg = 10 mg/hr
   • > 20 kg = 15 mg/hr
4. Magnesium Sulfate IV
   
   • 50 mg/kg (max: 2 grams)
5. Ipratropium Bromide (nebulized)
   
   • 1500 mcg x1 dose with albuterol

Question 4

What are the 3 phases of spacing albuterol once admitted?

Answer 4

1. Continuous albuterol
   
   • RT assess every 30min for 1 hour, then q1hr
2. Albuterol q2-3hrs (RT assess every other treatment)
   
   • < 20 kg = 4 puffs
   • > 20 kg = 8 puffs
3. Albuterol q4hrs (RT assess every other treatment)
   
   • < 20 kgs = 2 puffs
   • > 20 kgs = 4 puffs

consider PeP and incentive spirometry in stages 2/3

Question 5

What are the 4 component of Inpatient discharge criteria for asthma exacerbations?

Answer 5

1. no respiratory distress
2. SpO2 > 90% on room air
3. does not need albuterol < q4hrs
4. caregiver can provide albuterol q4hrs

Question 6

What are the 5 criteria for transfer to Intensive Care for asthma exacerbations? (any of the following)

Answer 6

1. prolonged cont. albuterol > 4 hrs + worsening sxs
2. PCO2 on cap gas > 45 mmHg
3. need for HFNC or NIV (non-invasive ventilation)
4. persistent sats < 90% despite O2 (> 3 LPM or >50% FiO2 with non-rebreather)
5. AMS (drowsiness)

Question 7

What are the mild and severe respiratory rates (RR) for these age groups when determining asthma severity?

1. 2-3 yo
2. 4-5 yo
3. 6-12 yo
4. > 12 yo

Moderate falls between these two

Answer 7

1. Mod <34/min and Severe >40/min
2. Mod <30/min and Severe >36/min
3. Mod <26/min and Severe >31/min
4. Mod <23/min and Severe >28/min

Question 8

What are the mild, moderate, and severe SpO2 level requirements for asthma exacerbation severity scoring?

Answer 8

Mild = > 95%

Mod = 90-95%

Severe = < 90%

Question 9

What are the mild, moderate, and severe auscultation finding requirements for asthma exacerbation severity scoring?

Answer 9

Mild = normal or end expiratory wheezes

Mod = Expiratory wheezes

Severe = Inspiratory AND Expiratory wheezes, OR dec. breath sounds

Question 10

What are the mild, moderate, and severe retraction findings for asthma exacerbations severity scoring?

Answer 10

Mild = none or intercostal

Mod = intercostal and substernal

Severe = intercostal, substernal, and supraclavicular

Question 11

What are the mild, moderate, and severe dyspnea findings for asthma exacerbation severity scoring?

Answer 11

Mild = speaks in sentences

Mod = speaks in partial sentences

Severe = speaks in single words or short phrases

Question 12

What effect does Magnesium Sulfate have when provided to asthmatics?

Answer 12

bronchoDILATOR

• also has anti-inflammatory effects