ACUTE INTERVENTION IN < 10 SLIDES! 1/25/2017 Pediatric Asthma ACUTE INTERVENTION IN < 10 SLIDES! 1/25/2017

Pathogenesis Inflammation Obstruction Hyper-responsivness - Origins of asthma primarily occur early in life. - The expression of asthma is a complex, interactive process that depends on the interplay between two major factors—host factors (particularly genetics) and environmental exposures that occur at a crucial time in the development of the immune system Pathogenesis PARTIALLY REVERSIBLE

Bronchoconstriction (bronchial smooth muscle contractions) Airway Edema Airway hyper-responsiveness (exaggerated bronchoconstriction) Airway remodeling Pathogenesis

Ipratropium  blocks acetylcholine receptors  bronchodilation Albuterol  stimulates beta-2 adrenergic receptors  relaxing airway smooth muscle

https://www.colorado.gov/pacific/sites/default/files/HTW_Asthma-Management-for-Children-and-Adults_03-21-2013.pdf

Asthma Ex: ER Triage O2 for <90% Ipratropium and albuterol x 3 <20 kg: 2.5 mg >20 kg: 5 mg Dexamethasone 0.6 mg/kg x 2 days Prednisone 2 mg/kg in 2 doses x 3-5 days Continuous neb and recheck in 1 hour <20 kg : 7.5 mg/hr >20 kg: 10 mg/hr Admission, IV Mag, noninvasive ventilation, ABG, CXR , transfer Based on Pediatric Assessment Severity Score: RR, O2, Auscultation, Retractions, Dyspnea Show on EPIC, respiratory flow sheet Oral = IV steroids for bioavailability Asthma Ex: ER Triage

Discharge criteria PAS score < 7 SpO2 > 90% on room air Continue BD q4 hr x 3 days, f/u, or oral steroids complete Rx ICS if h/o prior ED visit Asthma Education/Action Plan Discharge criteria

https://www.nhlbi.nih.gov/files/docs/guidelines/03_sec2_def.pdf Children’s Hospital Colorado https://www.colorado.gov/pacific/sites/default/files/HTW_Asthma-Management-for-Children-and-Adults_03-21-2013.pdf References