ED Pathway for Evaluation/Treatment
of Children with Asthma
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Respiratory Arrest
Imminent
To resuscitation room
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Moderate: ESI Triage 3
  • Consider prednisone/olone
  • If needed:
    Albuterol MDI -2-4 puffs
  • MDI spacer teaching
  • Discharge
  • Prednisone/olone
  • Albuterol MDI q20min x 3, prn RT assess
  • Prednisone/olone/Methylpred
  • Unineb: Albuterol x3 + ipratropium
  • Critical: consider SQ terb
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Reassess
ASSESS after completion of β-agonist
Considerations for further diagnostic testing
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Hold Treatment Reassess after 1 hr
Place admission order
Repeat albuterol via Unineb
Consider IV Mg
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Severe
Concern for Resp Failure
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Continuous albuterol
IV Mg bolus (if not given)
Consider terbutaline
SQ/IV bolus (no infusion)
Admit to ICU
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Mod / Severe
Needs continuous albuterol
Continuous albuterol
Consider IV mg bolus + NS
Admit to inpatient floor
Moderate
Needs q2h treatment
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Q2hr albuterol
Admit to floor/EDECU
Albuterol Weight-based Dosing
Kg Unit Dose (0.5%) MDI Puffs Continuous
5-10 2.5 mg (0.5 mL)47.5 mg/hr
>10-20 3.75 mg (0.75mL)611.25 mg/hr
>20 5 mg (1.0 mL)815 mg/hr
Ipratropium Weight-based Dosing
5-10 500 mcg over 1 hr in unineb or
250 mcg q20 min x 2
  
>10 1000 mcg over 1 hr in unineb or
500 mcg q20 min x 2
  
Prednisone/Methylprednisolone
 2 mg/kg p.o./IV, MAX 60 mg   
Magnesium Sulfate
 50 mg/kg, MAX 2 g
Give with Normal saline bolus, 20ml/kg (max 1 liter)
  
Terbutaline
 

Subcutaneous:
  0.01 mg(mL)/kg MAX 0.25 mg (0.25 mL)

Bolus
 10 mcg/kg
 (Range 2-10 mcg/kg) MAX 750 mcg

Infusion (consider intermittent boluses as alternative)
  Starting dose 0.4 mcg/kg/min
  (Range 0.4 mcg/kg-3 mcg/kg/min)
  Titrate to Max 3 mcg/kg/min

Posted : October 2005
Revised : November 2011, September 2013, October 2014
Authors : J. Zorc, MD; R. Scarfone, MD; A. Reardon, CRNP; N. Stroebel, CRNP; W. Frankenberger, RN; L. Tyler, RT;
D. Simpkins, RT; R. Abaya, MD; E. Delgado, MD; E. Brill, RN;