Acute Asthma Attack

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Acute Asthma Attack

Assessment of Severity

  • whether or not child can talk

  • presence of pulsus paradoxus

  • central cyanosis

  • usage of accessory muscles

  • hyperinflation of chest

  • wheeze or 'silent chest'

  • peak flow

Markers of life-threatening event (need ABG)

  • PEF <33% predicted / best

  • silent chest, cyanosis, feeble respiratory effort

  • bradycardia or hypotension

  • exhaustion, confusion, coma

Management

  • Consider intubation and ventilation

    • if exhaustion

    • if rising PaCO2

  • Oxygen

  • Bronchodilators

    • Beta2-agonists (nebulised) 2-4 hourly

    • ipratropium 500µg

  • corticosteroids

    • oral prednisolone 40mg

    • hydrocortisone 200mg IV

  • full assessment

    • tachycardia / tachypnoea

    • speech

    • pulsus paradoxus

    • breath sounds

    • GCS

    • PEFR

    • ABG

    • CXR

    • FBC, K+

    • Infection screen

  • Antibiotics if

    • fever

    • purulent sputum

    • raised WCC

  • involve senior

  • add in as necessary

    • IV aminophylline

    • IV magnesium sulphate

  • Once PEFR stable for 24 hours then home

    • attempt to find cause for exacerbation

 

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