Asthma: Mild/Moderate/Severe (Paediatric)
 
Status
Respiratory distress
   
Assess
Severity of distress
If Pt’s asthma Mx plan has been activated
         
Mild or Moderate
Salbutamol pMDI and spacer
- Deliver 4 puffs, 4 minutely until resolution of symptoms
If pMDI spacer unavailable
- Salbutamol 10mg (5ml) Nebulised
- Repeat Salbutamol 5mg (2.5ml) Nebulised, 5 minutely if required
         
Adequate Response   No Significant Response after 10 minutes
Transport with continued
reassessment		   Mx as per Severe
 
Severe
Salbutamol 10mg (5ml) and Ipratropium Bromide 250mcg (1ml) Nebulised
- Repeat Salbutamol 5mg (2.5ml) Nebulised, 5 minutely if required
Salbutamol 5mcg/kg IV
- Repeat 2.5mcg/kg IV, 2 to 3 minutely if required (max. 10mcg/kg)
Dexamethasone 600mcg/kg IV (max. 12mg)
If unimproved
- Salbutamol Infusion 2mcg/kg/min
 
Special Notes
Asthmatic Pts are dynamic and can show initial improvement with treatment then deteriorate rapidly.
Consider MICA support but do not delay transport waiting for backup.
Despite hypoxaemia being a late sign of deterioration, pulse oximetry should be used throughout Pt contact (if available).
An improvement in SpO2 may not be a sign of improvement in clinical condition.
Beware of Pt presenting wheeze associated with heart failure and no asthma / COPD Hx.
pMDI = Pressurised Metered Dose Inhaler
 
General Care

Salbutamol infusion via Syringe Pump and Standard Giving Set See Here