Acute asthma exacerbation

Work-Up

Order CXR if:

1. Fever

2. Worsening sx (return)

3. Poor response to Rx

4. 1st wheeze

(In order of severity)

1. Albuterol

    continuous = 0.15mg/kg/hr (max 20mg/hr)

2. Atrovent

3. Streoids (solumedrol/prednisone/prednisolone/dex)

    2mg/kg (inptn = 1mg/kg Q6hrs; outpt burst = 1mg/kg x4dy)

    or dexamethasone PO 0.6mg/kg (max 16kg) 1st dose, 2nd dose 36hrs after

4. Magnesium 50mg/kg (max 2gm IV over 20minutes)

5. Epi (1:1000) 0.01mg/kg (max 0.5mg) Q20min x 3 SQ

    Terbutaline SQ = same as Epi (max 0.25)

    *Caution in elderly/CHF

Peak Flow = (30 x age-in-yrs) + 30

Severe = <50% predicted Peak flow

Severe = <91% SaO2

Adapted from Donaldson, Rosen