Asthma: Unconscious (Paediatric) |
| Status |
| Unconscious / Becomes Unconscious - with poor or no ventilation but still with cardiac output |
| Pt requires immediate assisted ventilation | |
| Ventilate at: Infant 15-20 ventilations/min., Tidal Volume 10ml/kg Small child 10-15 ventilations/min., Tidal Volume 10ml/kg Large child 8-12 ventilations/min., Tidal Volume 10ml/kg |
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| Moderately high respiratory pressures | |
| Allow for prolonged expiratory phase | |
| Gentle lateral chest pressure during expiration if required | |
| Adequate response | Inadequate response | |||
| Mx as per Asthma - Severe Respiratory Distress CPG | Salbutamol IV, 5mcg/kg - Repeat Salbutamol IV, 2.5mcg/kg, 2 to 3 minutely if required (max. 10mcg/kg) |
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| Dexamethasone IV, 600mcg/kg (max 12mg) | ||||
| If unable to gain IV or unaccredited in IV Salbutamol - Adrenaline IM, 10mcg/kg (1:1,000 or 1:10,000) - Repeat 20 minutely as required (max 30mcg/kg IM) |
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| Mx as per Asthma - Severe Respiratory Distress CPG | ||||
| Consider intubation per Endotracheal Intubation CPG | ||||
| If Pt loses output at any stage, see Asthma - No Output | ||||
| Special Notes |
| High EtCO2 levels should be anticipated in the intubated asthmatic Pt. - EtCO2 levels of 120mmHg in this setting are considered safe, and when managing ventilations, be conscious of the effect of gas trapping when attempting to reduce EtCO2 . |
Extreme care must be taken with assisted ventilation as gas trapping and barotrauma occurs easily in asthmatic Pts with already high airway pressures. |