Asthma Flashcards
1
Q
Pt meeting criteria for this protocol
A
Known asthmatic or pt w/ continued wheezing after Tx.
2
Q
Pertinent Hx
A
- Intubation
- PICU admission
- Recent steroid/HHN/MDI use
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)
4
Q
Continuous Albuterol HHN Dosage
A
0.5 mg/kg/hr rounded up to nearest 5 mg
Max dose 20mg/hr
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
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)
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
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
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