Asthma, Pediatric, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • 2.7 million children (<18 yr) affected in US

  • 850,000 ED visits per year in US

  • Inflammatory events, usually viral, lead to bronchoconstriction:

    • Compounded by hyper-reactivity of airwa...

Diagnosis

Signs and Symptoms

General

  • Fatigue, somnolence

  • Diaphoresis, agitation

  • Hypoxia, cyanosis

  • Tachycardia

  • Dehydration

  • Pulsus paradoxus

Respiratory

  • Wheezing, rales, rhonchi

  • Cough, acute or chronic

  • Tachypnea

  • “T...

Treatment

Pre-Hospital

  • Oxygen and oxygen saturation monitoring

  • Nebulized β-adrenergic agonist: Albuterol

  • Intubate for respiratory failure or severe fatigue.

  • IV fluids if evidence of dehydration

  • Rapid trans...

Follow-Up

Disposition

Admission Criteria

  • Need to individualize based upon subjective and objective assessment

  • Persistent respiratory difficulty:

    • Persistent wheezing

    • Increased respiratory rate/tachypnea

    • Retr...

Pearls and Pitfalls

  • Rapid treatment with continuous re-evaluation to detect any progression of disease is essential.

  • When admitting patients, assure that β-adrenergic agent therapy is not interrupted.

Additional Reading

  • Krebs  SE, Flood  RG, Peter  JR, et al. Evaluation of a high dose continuous albuterol protocol for treatment of pediatric asthma in the emergency department. Pediatr Emerg Care. &#...

Codes

ICD9

  • 493.00 Extrinsic asthma, unspecified

  • 493.02 Extrinsic asthma with (acute) exacerbation

  • 493.90 Asthma, unspecified type, without mention of status asthmaticus

  • 493.10 Intrinsic asthma, unspecifie...

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