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Pediatric Inpatient Asthma Exacerbation Algorithm

Pediatric Inpatient Asthma Exacerbation Algorithm - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Respiratory, Related


Pediatric Inpatient Asthma Exacerbation Algorithm (Age 12 months to 17 years)
Was
the patient admitted from
the ED, and received 3
treatments?
Maintain pulse oximetry and
administer oxygen to maintain
SPO
2
>90%.
RT performs mPASS Assessment.
RT orders albuterol 2.5 mg Q5
min PRN (age < 12 yrs.) or 5 mg
Q5 min PRN (age > 12 yrs.)
Yes
Reference:
Asthma – Adult/Pediatric – Inpatient/Ambulatory/Emergency Dept Guideline
Maintain pulse oximetry and administer
oxygen to maintain SPO
2
>90%.
RT orders and gives albuterol 2.5 mg Q5 min
PRN (age < 12 yrs.) or 5 mg Q5 min PRN
(age > 12 yrs.) via nebulizer x3 within 1
st
hour.
RT orders and gives ipratropium bromide
250 mcg Q20 min (age < 5 yrs.) or 500 mcg
Q20 min (age > 5 yrs.) via nebulizer x3
within 1
st
hour.
RT performs mPASS Assessment.
No
Is mPASS score > 2,
and/or hypoxia?
Patient admitted to PICU
off of adjunctive therapies
(i.e., BiPAP, continuous
medications, etc.)
Patient admitted to
General Care
Inclusion Criteria:
1. Diagnosis of asthma or
history of recurrent
wheezing
2. Patients with first time
wheezing that have
demonstrated
responsiveness to
albuterol suggesting initial
presentation of reactive
airway disease
3. FiO2 < 50%
4. Exhibits one of the
following symptoms:
Persistent cough
Dyspnea
Chest pain
Wheezing
Exclusion Criteria:
1. Any patient on
adjunctive therapies
2. FiO2 > 50%
3. Concomitant diagnosis
including:
Cystic fibrosis or
other chronic lung
disease
Congenital or
acquired
cardiovascular
disease
Bronchopulmonary
dysplasia
Immunodeficiency
syndromes
RT give 1 Treatment Bundle*
RT may repeat Treatment Bundle up to three times in 1
st
hour based on
mPASS assessment. MDI is preferred delivery method per provider.
Yes
*Treatment Bundle:
1. mPASS Assessment
2. If mPASS score > 2, give initial dose of 4 puffs albuterol**
3. Repeat mPASS Assessment
4. If mPASS score continues to be > 2, repeat 4 puffs albuterol
5. Repeat mPASS Assessment
6. Senior Resident to notify Attending MD if mPASS score not improved
May repeat steps 1-5 up to three times in the 1
st
hour (equals 24 puffs).
No albuterol given.
RT reassess in 1 hour.
No
Is mPASS
score > 2?
Is mPASS
score > 2?
Call MD and agree
on a care plan.**
Yes
No albuterol given.
RT reassess in 1 hour.
No
RT give 1 Treatment Bundle* until mPASS score < 2.
RT reassess q1 hour.
Yes
RT reassess q1 hour.
Do not wean albuterol to q3
hours until patient off O
2
.
When mPASS score < 2 and no
albuterol is indicated for 4 hours,
change scheduled assessment
to q2 hours x2.
RT provide asthma education and
prepare for discharge.
No
**Notification of Resident MD by RT
- Initiation of or increasing requirement of supplemental O2
- Worsening or increasing respiratory distress
- Increasing frequency of bronchodilator therapy
- mPASS score > 2 after Treatment Bundle
- Unable to wean from q2 hour bronchodilator therapy after
receiving therapy for 6 hours (exclusion of ED protocol)
Notification of Attending MD by Resident
- Patient requires q2 hour bronchodilator therapy for > 8-12 hours
- Concern for patient condition
RT perform mPASS
Assessment
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org