Respiratory Conditions and management in the CHOA ED P. Patrick Mularoni, MD

Asthma At both the HS and Egleston there is a Respiratory Therapist in the ED There are protocols in place which allow for the immediate administration of both Albuterol and Atrovent These medicines are both preferentially given in the nebulized form

Asthma Albuterol -Intermittent treatments are given as: 2.5 mg for children < 15 kg 5 mg for children > 15 kg -Continuous treatments can be given as either 7.5, 10, or 15 mg over one hour

Asthma Atrovent 0.5 mg of this Anti-cholinergic medicine is given to patients to decrease cough, decrease secretions, and provide direct bronchodilatory activity

Steroids Solumedrol -Give 2 mg per Kg IV as an initial dose up to 60 mg per dose Prednisone (15 mg/5 ml) - Also give 2 mg/kg as an initial dos - most attendings give 2 mg/kg per day for 5 days

Magnesium Given for its smooth muscle dilation properties it is given IV at 40 mg/kg This is the third line treatment chosen most often at CHOA Watch patients blood pressure Patients who resolve pst Magnesium can still go home

Terbutaline Given as a sub-Q Beta agonist.01 mg/kg up to a maximum dose of 0.5 mg Sub Q Epi can also be given as.01 mg/kg per dose Usually given as the 1:1000 form so it ends up being.01 ml/kg Max dose is 0.5 ml

Ketamine For patients who are hyperventilating to a point that respirations are uneffective or for those where a CPAP trial is warranted Ketamine can be given at a dose of mg/kg

Croup Racemic Epinephrine is given at a dose of.05 ml/kg/dose This can be given q 15 minutes Decadron should also be given at a dose of 0.6 mg/kg * If Racemic is given for stridor patients must be observed for at least 2 hours

Bronchiolitis RSV season begins in the ATL in August No we don’t have any “real treatments” for RSV here either Please try to get patients to the Trauma room before intubating them

Foreign Bodies FB’s are handled by the surgery team Before calling them please get a nose to rectum X ray If a patient had an X ray at an outside institution, repeat the X ray then call your friendly surgeon

Respiratory Failure We have CPAP machines available at both campuses There is also High flow O2 that comes from the NICU for small patients needing extra PEEP

Intubation Respiratory will be present at all intubations Fellows are not permitted to intubate a patient outside the ED without direct attending supervision

Intubation We have moved to an Etomidate and Rocuronium for RSI Unless contraindicated use Etomidate 0.3 mg/kg and then Vecuronium 0.1mg/kg Atropine can be used but many of us are not using it presently Don’t forget Lidocaine if your worried about increased ICP