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3-13. Status Asthmaticus

Status asthmaticus is a severe, prolonged asthma attack that does not respond to conventional methods of treatment. This condition is considered a medical emergency. Proceed in the following manner with patients having this type of asthma attack:

a. History. It is important to know the patient's recent medical history. Ask the questions listed below of or about the patient. Then, record that information.

(1) How long has the child been wheezing?

(2) How much fluid has the child taken?

(3) Has the child had a recent infection?

(4) What medications has the child been given? When were the medications given, and what was the amount of each medication?

(5) Is the child allergic to anything? If so, what?

(6) Has the child been hospitalized recently?

b. Physical Examination. Give the child a physical examination, paying particular attention to the following:

(1) General appearance. Is the child sitting or lying down? In how much distress is the child? A child having a mild asthmatic attack will lie down but prefers to sit. A child having a severe asthmatic attack appears exhausted and may be unable to move from the position he is in.

(2) State of consciousness. Very serious signs include sleepiness, stupor, and coma. These signs indicate the patient is experiencing severe degrees of hypercarbia, hypoxemia, and acidosis.

WARNING: A patient having an asthma attack and being very sleepy at the same time is seriously ill.

(3) Vital signs. As the asthma attack becomes more severe, the patient's pulse becomes weaker and faster, and his blood pressure falls.

(4) Skin and mucous membranes. Check the child's skin for signs of dehydration. Check his lips and nailbeds for evidence of cyanosis.

(5) Chest sounds.

(a) Listen to the child's respiratory sounds. You are checking for rales (abnormal respiratory sounds, sounding high-pitched or like rubbing hair together near your ear), and wheezes (high- pitched, whistling sounds). The patient's chest sounds are noisy in a mild or moderate asthma attack. As the asthma attack progresses, there are increased breath sounds with loud, expiratory wheezes and sometimes rales. As the asthma attack becomes even more severe, the patient's breath sounds are harder and harder to hear.

(b) Be sure to listen to the child's entire chest. A child with localized wheezing may have a foreign body obstructing his airway. A child with asthma, however, will have wheezing which can be heard all over his chest.

CAUTION: A silent chest means danger!

c. Treatment. Treatment is similar to that for acute asthma and includes the following:

(1) Administer humidified oxygen by mask.

(2) Begin an IV lifeline with D5/W or D5/.25 normal saline.

(3) Give epinephrine 1:1000 SQ in the dose of 0.01 mg per kilogram. Repeat in 20 to 30 minutes.

CAUTION: Remember, the use of epinephrine may be hazardous to the child if he has already taken high doses of bronchodilator medication by inhalation! To avoid such a medication mistake, be sure you have taken a good history of the child

.(4) You may administer aerosolized bronchodilator through the nebulizer. Epinephrine or bronchosol may be given. Monitor the child's heart rate and discontinue the nebulizer if his heart rate exceeds 160 beats per minute or if dysrhythmias develop.

(5) Encourage the child to cough up any secretions as he takes the bronchodilator treatment.

(6) Be prepared to administer these medications:

(a) Aminophylline, in the dosage 2 to 4 mg per kilogram diluted in at least 10 ml of D5/W, to be given IV over no less than 15 minutes.

(b) Hydrocortisone in the dosage 5 mg per kilogram drawn up in a syringe to be added to the IV bag.

(7) Monitor the child's cardiac rhythm.

3-14. Bronchiolitis

David L. Heiserman, Editor

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All Rights Reserved

Revised: June 06, 2015