Asthma Escalation Pathway
At any point during the escalation of care, please consider calling the CAT team
if additional bedside support is needed by any team member.
Patient
Classification:
Severe
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Assessment
Is patient improving
on continuous
Albuterol?
YES
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Continue with
Severe
Management
Guidelines
NO
NO
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Ordering Provider Verifies time of
last systemic Corticosteroid dose
Processes happen
simultaneously
Provider order for Magnesium Sulfate (to be sent to floor STAT) and normal saline bolus
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Was the last dose given within the ordered time frame? (i.e. 6 or 12 hours)
YES
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Administer next dose at appropriate scheduled time
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NO
Administer appropriate systemic corticosteroid dose
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Provider order
for Subcutaneous
Terbutaline per
dosing guidelines
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Nurse administers Subcutaneous Terbutaline per Physician order
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Assessment in 5-10 minutes
Is patient improving after Subcutaneous Terbutaline dose?
YES
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Hold Magnesium dose and reassess in 15 minutes
NO
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Assessment:
Has patient continued to improve after Subcutaneous Terbutaline dose?
YES
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Continue with
Severe Management Guidelines
NO
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Has Magnesium Sulfate arrived on the floor?
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YES
NO
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Repeat Subcutaneous Terbutaline dose
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Nurse administers IV normal saline bolus then administers IV magnesium sulfate per provider order
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Assessment:
Is patient improving after Magnesium Sulfate infusion?
NO
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Arrange for PICU transfer and call CAT team if not previously called.
YES
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Continue with Severe Management Guidelines

* Addendum to Asthma Practice Pathway:
Severe Management Guidelines

** Patient should remain on continuous
Albuterol as ordered

Posted: June 2011
Revised: November 2011, November 2013
Authors: M. Magnusson, MD
Evidence Reviews