Paediatric Asthma Flashcards
Nebuliser masks require a minimum fluid volume of ____mL to operate correctly. How does this influence Salbutamol admin in paediatric asthma?
5mL.
For doses less than 1 amp of Salbutamol, dilute up to 5mL with Normal Saline.
Why should caution be used when administering Salbutamol to children?
It can cause profound lactic acidosis, and should be reserved for severely ill children.
Children of what age group should not receive Salbutamol?
<2.
When using pMDI, if a child has their own mask and spacer is this preferable to AV spacers?
Yes. Use child’s own if possible.
What are the signs associated with Mild/Moderate paediatric asthma?
Normal conscious state, some increased
work of breathing, tachycardia, speaking in phrases/
sentences.
What are the signs associated with Severe paediatric asthma?
Agitated/distressed, markedly increased work
of breathing, including accessory muscle use/retraction,
tachycardia, speaking in words.
What are the signs associated with Critical paediatric asthma?
Altered conscious state, maximal work of
breathing, marked tachycardia, unable to talk.
Why are there no specific vital signs associated with determining the severity of paediatric asthma?
Normal vital signs vary significantly within age groups.
What is the preferred route of Salbutamol admin in children with mild/moderate respiratory distress?
pMDI. If not available, nebulise salbutamol as per Severe Respiratory Distress.
What is the management for Mild/Moderate paediatric asthma?
Salbutamol pMDI via spacer:
≥6 = 4 to 12 doses
2 - 5 = 2 to 6 doses
4 breaths per dose, can be repeated after 20mins
If no significant response after 20mins, Rx as Severe.
If adequate response, Tx, monitor and rpt Salbutamol as required.
What is the management for Severe paediatric asthma?
Nebulised Salbutamol
Sml children = 2.5mg
Med children = 2.5 - 5mg
- Rpt at 20min intervals if required
Ipratropium bromide 250mcg all ages
What is the management for Critical paediatric asthma?
1. Nebulised Salbutamol All ages = 10mg - Rpt 5mg at 5 minute intervals 2. Ipratropium Bromide 250mcg 3. IM Adrenaline 10mcg/kg - Rpt 5-10mins, max 30mcg/kg (3 doses) 4. Dexamethasone 600mcg/kg oral, max. 12mg
What is the target ventilation pressure for paediatric patients?
Enough pressure to see visible chest rise and fall.
If the paediatric pt becomes unconscious with poor/no ventilation but still has cardiac output, what is the Mx?
Ventilate at:
Small child = 12 to 15 v/m
Medium child = 10 to 14 v/m
- aim for visible rise and fall of the chest
- use moderately high respiratory pressures
- allow for a prolonged expiratory phase
- apply gentle lateral pressure during expiration
If the paediatric pt does not respond to Mx for “unconscious with poor/no ventilation but still has cardiac output” what is the Mx?
Rx as per Critical Asthma (Adrenaline) and monitor for loss of cardiac output.
