Asthma Clinical Pathway – Inpatient – No Improvement on Continuous or Adverse Effects

No Improvement on Continuous or Adverse Effects

Stable, No Improvement	Normal saline bolus and IV magnesium sulfate bolus if received < 2 prior magnesium sulfate boluses since arriving in the ED
Stable, Not Improving, and Experiencing Side Effects	Consider either or both of the following: Normal saline bolus and IV magnesium sulfate bolus if received < 2 prior boluses since arriving in the ED Trialing off continuous albuterol to q1hr albuterol PRN for 2 consecutive doses Note: RN and RT should partner to ensure q1hr assessments Do not continue beyond 2 hrs After 2 hrs, assess ability to space to q2hr, need to return to continuous, or call Critical Assessment Team (CAT)

Stable, No Improvement

Normal saline bolus and IV magnesium sulfate bolus if received < 2 prior magnesium sulfate boluses since arriving in the ED

Stable, Not Improving, and Experiencing Side Effects

Consider either or both of the following:
1. Normal saline bolus and IV magnesium sulfate bolus if received < 2 prior boluses since arriving in the ED
2. Trialing off continuous albuterol to q1hr albuterol PRN for 2 consecutive doses
  - Note: RN and RT should partner to ensure q1hr assessments
  - Do not continue beyond 2 hrs
  - After 2 hrs, assess ability to space to q2hr, need to return to continuous, or call Critical Assessment Team (CAT)

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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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Asthma Clinical Pathway – Inpatient – No Improvement on Continuous or Adverse Effects

No Improvement on Continuous or Adverse Effects