Asthma Clinical Pathway — Inpatient

No Improvement on Continuous or Adverse Effects

Consult with the patient’s respiratory therapist and bedside nurse when considering the below options:

  • If patient has been on continuous albuterol for > 12 hours and with no signs of clinical improvement (but patient is not experiencing worsening respiratory distress or showing signs of tiring), consider:
    • Ordering a normal saline bolus and IV magnesium sulfate bolus (if the patient has received < 2 prior magnesium sulfate boluses since arriving in the ED)
  • If patient has been on continuous and is not improving (but not worsening) but is experiencing discomfort from side effects such as tachycardia, consider either or both of the following:
    • Ordering a normal saline bolus and IV magnesium sulfate bolus (if the patient has received < 2 prior magnesium sulfate boluses since arriving in the ED)
    • Trialing the patient off continuous albuterol on Q1 albuterol PRN for 2 consecutive doses [note: this must be done in concert with nursing and RT and should not be continued beyond 2 hours. After 2 hours, the providers should confer as to whether patient could space to Q2 hours, return to continuous, or consult with the Critical Assessment Team (CAT)]

 

Asthma — Asthma Escalation Pathway — Clinical Pathway: Inpatient

No Improvement on Continuous or Adverse Effects

Consult with the patient’s respiratory therapist and bedside nurse when considering the below options:

  • If patient has been on continuous albuterol for > 12 hours and with no signs of clinical improvement (but patient is not experiencing worsening respiratory distress or showing signs of tiring), consider:
    • Ordering a normal saline bolus and IV magnesium sulfate bolus (if the patient has received < 2 prior magnesium sulfate boluses since arriving in the ED)
  • If patient has been on continuous and is not improving (but not worsening) but is experiencing discomfort from side effects such as tachycardia, consider either or both of the following:
    • Ordering a normal saline bolus and IV magnesium sulfate bolus (if the patient has received < 2 prior magnesium sulfate boluses since arriving in the ED)
    • Trialing the patient off continuous albuterol on Q1 albuterol PRN for 2 consecutive doses [note: this must be done in concert with nursing and RT and should not be continued beyond 2 hours. After 2 hours, the providers should confer as to whether patient could space to Q2 hours, return to continuous, or consult with the Critical Assessment Team (CAT)]