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Status Asthmaticus

See Also
Management: Follow Initial Management per other protocols
1. See Asthma Exacerbation Management in the ER
2. See Asthma Inpatient Management
Management: Additional Measures for extremis
1. Nebulized Albuterol with Atrovent hourly or Continuous
2. Systemic Corticosteroid
3. Epinephrine 0.01 mg/kg up to 0.3 mg SC
  1. May be repeated every 5 minutes
4. Oxygen 100% (warm, humidified) by nonrebreather mask
5. Two Intravenous Lines
6. Intubation and Mechanical Ventilation
  1. Intubation is best done semi-electively before crisis
  2. Intubation criteria are based on clinical judgment
  3. Oral intubation is preferred
    1. Lower resistance and easier suctioning
    2. Lower Incidence of Sinusitis
  4. Indications
    1. Impending or actual respiratory arrest
    2. Extreme Fatigue
    3. Altered mental status
    4. Significant respiratory distress
    5. Severe Respiratory Acidosis and Metabolic Acidosis
7. Consider Magnesium 40 mg/kg up to 2 grams IV for 1 dose
  1. Rapidly effective in pediatric Asthma exacerbations
  2. Also shown effective in severe adult acute Asthma
  3. Some studies question benefit
  4. References
    1. Silverman (2002) Chest 122:489
    2. Hughes (2003) Lancet 361:2114
8. Consider Heliox (helium to oxygen 80:20 70:30 or 60:40)
  1. Reduces work of breathing and improves Peak Flow
  2. Risk of Hypoxemia
9. Consider Aminophylline or Theophylline
References
1. (1997) Management of Asthma, NIH 97-4053
2. (1995) Global Strategy for Asthma, NIH 95-3659
3. Ciarallo (2000) Arch Pediatr Adolesc Med 154:979
4. Sarfone (2000) Ann Emerg Med 36:572

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.