Initial Assessment
Assess the Heart Rate, Respiratory Rate, O2 saturation, Peak expiatory flow rate, Use of accessory muscles, Pulsus paradoxus ( more than 20 mmHg difference in systolic B.P for inspiratory versus expiratory phase ) , Dyspnea, Alertness, Colour.
Initial Management
1. Give O2 to keep saturation > 95%.
2. Administer inhaled B- agonists: Nebulized albuterol 0.05 to 0.015 mg/kg/dose every 20 minutes or continuously depending on the condition.
3. Other nebulized bronchodilators that can be used include ipratropium bromide 0.25 to 0.5 mg.
4. If the air movement is poor or the patient is unable to cooperate with a nebulizer give epinephrine 0.01 ml / kg SC . It can be given every 15 minutes upto 3 doses.
5. Starting Steroids: If there is no response after one nebulized treatment or if the patient is steroid dependent or had a recent emergency depertment visit or an ICU care needed start prednisolone 2 mg/kg /day divided 6 hrly.
6. Consider obtaining arterial blood gases if the response is poor and breath sounds are minimal.
7. Continue nebulization every 20 to 30 minutes.
8. Administer MgSO4 25 to 75 mg /kg/dose IV or IM ( max. 2g ) infused over 20 minutes every 4 to 6 hrs upto 3 to 4 doses.
9. Althougy Aminophylline may be considered it is no longer a preferred therapy for status asthamaticus.
10. Intubation of those with acute asthma is dangerous and should be reserved for impending respiratory arrest.
Indications for Intubation
- Deteriorating Mental status
- Severe cyanosis
- Respiratory or Cardiac arrest.
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