PAEDIATRICS

ResponseDose:
5 or under: 6 puffs Salbutamol, 4 puffs ipratropium.
6 or over 12/8 puffs

Oxygen to saturations >=90%
Bronchodilators: Salbutamol + Ipratroium Q20 mins x 3 doses
Steroids: Hydrocortisone 4mg/kg IV
Reassess 30 mins after doses
Continue Salbutamol Q20 min (Or more) and admit
Atrovent 4th hourly

ResponseBronchodilator doses:
5 or under: 2.5mg salbutamol neb, 250 mics ipratropium neb
6 or over: 5mg/500 mics

Oxygen (HFNP/CPAP/BIPAP) Saturations >=90%
Inhaled bronchodilators - Continuous nebs (doses as above)
Consider IM adrenaline 10 mic/kg (1:1,000 lateral thigh) and repeat Q5 min
IV access
Steroids - Hydrocortisone 4mg/kg
Magnesium sulphate 0.2 mmol/kg (max 8mmol) over 20 mins

• Adverse: hypotension, bradycardia, vomiting

Aminophyline 10 mg/kg (max 500 mg) over 30 mins with cardiac monitoring (rpt 6h)

• Adverse: tachycardia, tachyarrhythmias, N+V, tremors

(Note mag + aminophyline are not compatible - if given simultaneously need 2 lines)

Consider IV salbutaml (last resort) - 5-15 mics/kg over 10 mins + repeat
Infusion 1-2 mics/kg/min titrate up to 5 mics/kg/min

• Salbutamol adverse - Hypokalaemia, met acidosis, Lactaemia, Tachycardia, nausea, headache (the same as inhaled but more severe)

IV fluids - not in RCH guidelines but 10-20 mL/kg N/S if hypotensive (will be dry)

In life-threatening acute asthma, IM adrenaline can provide bronchodilation in children with poor respiratory effort to optimise delivery of inhaled therapy
Above from RCH (not taken from answers)

ResponseHypoxia
Hypercarbia
Apnoea
ALOC
Ptx
Vomiting
Agitation (secondary to salbutamol toxicity)

ResponseHypoxia/preoxygenation - HFNC 15L/min throughout, Consider BiPAP as preoxygenation strategy. Avoid apnoea
Induce sitting up

ResponseRR <10 (should be low to allow time for expiration)
TV 5-7 mL/kg - decreases barotrauma
Peak inspiratory pressure - 35-50 cm.H20 - necessary to overcome high airway pressures
Plateau pressure <30 cm.H2O
PEEP 0-5cm.H20 - Patient has high intrinsic PEEP - low extrinsic PEEP prevents gas trapping
I:E ratio - 1:4-1:8 - allows time for expiratoin

ResponseDynamic hyperinflation/gas trapping
Tension pneumothorax
Effect of induction agent
Hypovolaemia
Equipment failure (tube dislodged/O2 not connected)

AAHH SHITE + DOPES Mnemonic

ResponseAdequate oxygenation, oral intake
Salbutamol weened to 3-4 hourly
Adequate parental education and ability to deliver salbutamol
Follow up appropriate (Eg: GP)