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Status Asthmaticus in children : Summary




Status Asthmaticus

Definition: severe exacerbation of asthma that dose not improve with standard therapy

1-                  Admit the patient   in ICU
2-                  Enquire  about history of
Evaluate+Assess
                        a)     Known Asthmatic, or first episode
 b)     Treatment receiving as bronchodilators, steroids inhalers,
        Oral steroids, nsaids
 c)     History of Fever, Rhinahoe Cough
 d)     Exacerbating –factors ,exposure to drugs, allergens, smoke
                        e)     Previous admissions in emergency

                                                            I/V fluids

            General conditions of the patient, conscious, able to talk, audible wheeze cyanosis, silent chest.

2-         O2   inhalation

3-         Nebulization
            (Send samples)(Investigation)
                                     
                                                PFR:
                                                CXR:
                                                ABG:  Resp Audosis, Resp Alkalosis
                                                                        Repeat
                                                CBC:

4-         Ventolin: Nebulization + O2   age <I Year

            AGE < I YEAR ventolin solution 0.25+ 2.5 cc normal saline
            AGE >I YEAR ventolin solution 0.50 + 0.5cc normal saline
            Nebulize   ½ hourly   x   3 times        
             If   patient does not improve then nebulize continuously

5-         Ipartropium
                                                Nebulization 0.5 mg / 2.5 ml x 2----4 hourly

6-         Inj Epinephrine 0.05 mg         s/c

7-         Magnesium Sulfate    
                                                25-75 mg / kg
                                                Max 2.5 g 1/V20



9-         Terbutaline Sulfate
                                                If persistent acidosis O2 Saturation not improving

10-       Start Ambu Bag and Mask – if there is CNS depression or respiratory arrest
                                                Endotracheal Intubation

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