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

2. 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

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

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

6. 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

7. 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

8.
Children’s Hospital Colorado
References