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Asthma - Treatment in Emergency Room

  • Initial assessment- brief physical exam, Peak Expiratory flow (PEF) or Forced Expiratory Volume in 1 second (FEV1)
        
  • FEV1 or PEF >40% (Mild to Moderate)
    • Oxygen to keep SpO2 >90%
    • Short acting beta-2 –agonist (SABA) by Jet Nebulizer or Meter Dose Inhaler (MDI) with holding chamber x 3 doses in first hour 
    • 2.5 to 5 mg nebulized
    • 2-4 puffs MDI
    • Oral systemic corticosteroids (2mg/kg)
          
  • FEV1 or PEF <40% (Severe)
    • Oxygen to keep SpO2 >90%
    • High dose SABA by nebulizer every 20 minutes or continuously for 1hour
    • With the addition of Ipratropium bromide 
    • 5mg to20 mg nebulized SABA with 0.5 mg Ipratropium Bromide
    • 6-8 puffs with holding chamber
    • Oral systemic corticosteroids (2mg/kg)
          
  • Impending or actual Respiratory arrest
    • Intubation and mechanical ventilation
    • Oxygen with 100%
    • Nebulized SABA and Ipratropium bromide
    • Intravenous corticosteroids
    • Consider adjunct therapies

SABA- Albuterol, Pitbuterol,Levalbuterol

The information provided is intended as a resource only not medical advice. 

Reference article: National Asthma Education and Prevention Program Expert panel 3 “ Guidelines for the diagnosis and management of asthma” 2007