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Adult ED Asthma Exacerbation Algorithm

Adult ED Asthma Exacerbation Algorithm - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Respiratory, Related


Adult patient presentation to ED with asthma exacerbation
RT perform spirometry (if patient able)
Does patient
have any of the following?*
- FEV1 or PEF < 40% or unable to perform spirometry due to work of breathing?
- Diffuse wheezes or poor air movement without wheezes?
- Breathless at rest/agitated or confused?
- In need of O
2
to keep SpO
2
> 92%?
Moderate or Severe Exacerbation
HIGH DOSE THERAPY
RT order and give albuterol 5 mg Q20 min x3 in 1
st
hour
via nebulizer
RT order and give ipratropium bromide 500 mcg Q20
min x3 via nebulizer
Administer O
2
to maintain SpO
2
>92%
Oral corticosteroids per ED provider
Consider EtCO
2
or arterial blood gas per ED provider
Yes
Mild Exacerbation
STANDARD DOSE THERAPY
RT order and give albuterol 5 mg via nebulizer x1.
RT order and give ipratropium bromide 500 mcg via
nebulizer x1 (if using albuterol at home > q2-4 hours).
Administer O
2
to maintain SpO
2
>92%
Oral corticosteroids per ED provider
No
RT assess response to intervention
(including spirometry)
Good Response
Patient exhibits at least one of the
following:
FEV1 or PEF > 70%
No distress, normal exam
Response sustained for > 60 min.
Incomplete Response
Patient exhibits at least one of the
following:
FEV1 or PEF = 40-69%
Mild or moderate symptoms*
RT order and give albuterol via MDI with
spacer x8 puffs or 5 mg Q20 min. x2 via
nebulizer.
MDI therapy is the preferred delivery
method. If the patient is unable to perform
MDI therapy adequately, give treatments
via nebulizer.
Initiate Discharge
Planning
Administer O
2
to maintain SpO
2
>92%
IVF per ED provider
ED provider to consider possible
intubation and ventilation or adjunctive
therapies: Heliox (if FiO
2
< 50%); BiPAP;
HFNC; Magnesium sulfate 50-75 mg/kg
(max 2 g) over 20 min
Continue Reassessment and Admission Planning
RT notify ED provider
Reference:
Asthma – Adult/Pediatric – Inpatient/
Ambulatory/Emergency Dept Guideline
Admit to Hospital
Adult ED Asthma Exacerbation Algorithm (Age 18 years or older)
Incomplete or Poor Response
Patient exhibits at least one of the
following:
FEV1 or PEF < 70%
PCO2 > 42 mmHg
Mild, moderate, or severe
symptoms*
Significant distress
RT assess response to intervention
(including spirometry)
Poor Response
Patient exhibits at least one of the
following:
FEV1 or PEF < 40%
PCO2 > 42 mmHg
Severe symptoms*
Significant distress
Good Response
Patient exhibits at least one of the
following:
FEV1 or PEF > 70%
No distress, normal exam
Response sustained for > 60 min.
RT notify ED provider
RT notify ED provider
RT notify ED provider
RT notify ED provider RT notify ED provider
RT order and give albuterol
continuous at 0.5 mg/kg over 1 hour
(up to 15 mg/hour) via nebulizer
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org