Asthma Management and References - Guidelines for Admission

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Dr C.T.Deshmukh
Professor of Pediatrics, K.E.M Hospital

Asthma Management and References

Continued...

Guidelines for admission:

Do not admit if:

Comfortable at rest.

No chest retractions.

Not using accessory muscles of respiration.

O2 saturation > 90 % at room air.

Admit if :

Labored respirations continue.

O2 saturation < 90 % at room air.

Dehydration, which requires intravenous fluids.

Past history of rapid deteriorations.

PEFR < 50 % or diurnal variation > 25 %.

Presence of complications such as subcutaneous emphysema and pneumothorax.

Do not keep patient for observation with simple measures for more than 3 - 4 hours, it is better to admit such patients for more intensive therapy and observation.

Treatment after admission:

Continue humidified oxygen monitoring pulse oximeter.

Continue inhaled ß2 agonist frequently depending on clinical and PEFR findings.

Intravenous fluids are needed in most with severe asthma as they are dehydrated due to - increased metabolism, increased insensible losses, decreased intake, vomiting. Dehydration can increase viscosity of secretions, thereby increasing bronchiolar plugging and atelectasis. Over hydration can cause pulmonary edema. Hence correct the dehydration, then provide maintenance fluids, monitor fluid and electrolytes and correct accordingly.

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