Acute Asthma Exacerbation Clinical Pathway – Inpatient and PICU – History and Physical

History

Past Medical History	Time of onset of exacerbation Potential triggers Severity of symptoms compared with previous exacerbations Response to treatments prior to admission For the past year/lifetime, estimate number of asthma-related Office visits ED visits Hospitalizations ICU admissions/need for intubation
Medications	All current medications, time of last dose Number of courses of systemic steroids in the last year Adherence with controller medications, use of spacer
Persistent Symptoms	In the last 4 wks, prior to current exacerbation Use of rescue medication Albuterol Levalbuterol Inhaled corticosteroids (ICS) Nighttime symptoms Exercise intolerance Presence of complicating illnesses Pulmonary Cardiac Diseases aggravated by steroid therapy Diabetes Hypertension Ulcers Psychosis

Physical

General	Vital signs, pulse oximetry Level of alertness Hydration status Presence of cyanosis, pallor
Respiratory	Respiratory distress Wheezing, decreased aeration Identify complications Pneumonia Pneumothorax Pneumomediastinum Rule out upper airway obstruction Croup Foreign body

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Acute Asthma Exacerbation Clinical Pathway – Inpatient and PICU – History and Physical

History

Physical