ED Pathway for Evaluation/Treatment of Children with Asthma

MD/CRNP/RN Brief Rapid Assessment

Brief History
  • Time of onset of exacerbation
  • Potential causes
  • Severity of symptoms compared with previous exacerbation
  • Response to treatments prior to admission
  • All current medications, time of last dose
    • Last course of systemic steroids
  • Estimate number of:
    • Previous office, ED visits for asthma exacerbations
    • Hospitalizations for asthma, especially in the last year
    • Respiratory insufficiency due to asthma (LOC, intubation, ICU admissions)
  • Presence of complicating illnesses (pulmonary, cardiac)
  • Diseases aggravated by steroid therapy (diabetes, hypertension, ulcers, psychosis)
Brief Physical Exam
  • Assess the severity of the exacerbation
  • VS, pulse oximetry
  • Level of alertness
  • Hydration status
  • Presence of cyanosis, pallor
  • Respiratory distress
  • Wheezing, decreased aeration
  • Identify complications:
    • Pneumonia
    • Pneumothorax
    • Pneumomediastinum
  • Rule out upper airway obstruction (croup, foreign body, etc.)