Acute exacerbation of asthma- management | Status asthmaticus|EMERGENCY MEDICINE|Pediatrics lecture

Summary

In this video, the speaker provides a comprehensive guide on managing acute exacerbation of asthma in children, emphasizing the importance of risk assessment and a structured treatment protocol. Key steps include administering oxygen, using inhaled bronchodilators like salbutamol, and systemic corticosteroids. The video also outlines the flowchart for treatment escalation and criteria for discharge, highlighting the necessity of a home written action plan to significantly reduce asthma-related risks. This informative session is crucial for medical students and practitioners aiming to enhance their understanding of pediatric emergency management.

Takeaways

• 😀 Acute asthma exacerbation requires immediate risk assessment through focused history and clinical assessment.
• 🩺 Vital signs, including respiratory rate and SpO2, should be monitored to evaluate the severity of the exacerbation.
• 💨 Administer moist oxygen to maintain SpO2 levels above 92% to prevent hypoxia.
• 🚑 Inhaled bronchodilators like Salbutamol and Lio Salbutamol are essential first-line treatments for asthma exacerbations.
• 💊 Systemic corticosteroids, such as Prednisolone or Hydrocortisone, should be administered if the child cannot take oral medications.
• 🔄 If standard treatments are ineffective, consider adding anticholinergic drugs like Ipratropium Bromide.
• ⚠️ Adrenaline may be necessary in severe cases, with specific dosages based on weight.
• 🧪 Magnesium sulfate is an option for non-responding patients to enhance bronchodilation.
• 🔄 Mechanical ventilation is a last resort for children not responding to medical management in acute situations.
• 🏠 Discharge planning should include a home-written action plan to significantly reduce asthma-related deaths.

Q & A

What is the first step in managing a pediatric patient with acute exacerbation of asthma?

The first step is to conduct a risk assessment, which includes taking a focused history and performing a quick clinical assessment of the child.

What key elements should be included in the focused history during a risk assessment?

Key elements include the frequency of daytime and nighttime symptoms, potential triggers, and the child's current medications.

What vital signs should be assessed during the clinical evaluation?

You should check the respiratory rate, vital signs, the use of accessory muscles for respiration, and perform pulse oximetry.

What is the target SpO2 level to maintain when administering oxygen therapy?

The target SpO2 level is above 92%.

What are the preferred bronchodilators for acute exacerbation of asthma, and how are they administered?

Salbutamol and Levosalbutamol are the preferred bronchodilators, administered via nebulization or MDI (metered-dose inhaler).

How should salbutamol be dosed when given via nebulizer?

Salbutamol should be given at a dose of 0.15 mg/kg per dose, repeated at least three times, 20 minutes apart.

What are the potential side effects of using bronchodilators?

Possible side effects include palpitations, tachycardia, tremors, and anxiety.

What systemic corticosteroid is recommended for children who can take medication orally, and what is its dosage?

Prednisolone is recommended, at a dose of 1-2 mg/kg per day in divided doses.

What should be done if the child does not respond to initial treatments?

If there is no response, you can give adrenaline, magnesium sulfate, or consider mechanical ventilation as a last resort.

What criteria should be met before discharging a child after an asthma exacerbation?

Criteria include being hemodynamically stable, maintaining SpO2 above 92% without oxygen, taking bronchodilators every three hours, and having a written action plan for home management.