Asthma Flashcards

1
Q

Pt meeting criteria for this protocol

A

Known asthmatic or pt w/ continued wheezing after Tx.

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2
Q

Pertinent Hx

A
  • Intubation
  • PICU admission
  • Recent steroid/HHN/MDI use
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3
Q

Asthma Assessment

A
  • 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)
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4
Q

Continuous Albuterol HHN Dosage

A

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

Max dose 20mg/hr

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5
Q

Atrovent HHN Dosage

A

<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

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6
Q

Solu-Medrol IV dosage

A

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)

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7
Q

Response to Tx

A
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
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8
Q

Xopenex

A
  • May be substituted if pt already on medication or severly tachycardic
  • Dosage: <12 y/o 0.63 mg, >12 y/o 1.25 mg
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9
Q

Continued poor response after interventions

A

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
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