WPH EC Cheat Sheet

Paediatric
Asthma
A Excl Airway RESUSCITATION TRIAGE Severe Asthma Life Threatening
Obstruction • talk / feed • Silent Chest
ABCDE SpO2 • RR: >5 yrs >30 / min • Exhaustion → coma

B Excl Tension Pneumo

O2 if SpO2 < 94%
2-5yrs > 50 / min
• PR: >5 yrs >120/min
• LOC: agitated /
• Hypotension
2-5yrs > 130/min • Exhaustion → coma
Hx Ex PEFR

Life
Mild Moderate Severe
Threatening

POSSIBLE DISCHARGE ADMIT (Possibly ICU)

Nebulized Beta-2-Agonist
Immediate Management
(Salbutamol neb <5yrs – 2.5mg; >5yrs – 5mg mixed with N/S to 4ml)
Oxygen 40-60%
Salbutamol MDI (1puff / 5 breaths. Total 20 puff/20min)
β2 Agonist Neb continuously (later q20min)
O2 to keep SpO2>94% (Salbutamol neb <5yrs – 2.5mg; >5yrs – 5mg mixed with N/S to 4ml)
Ipratroprium Bromide Neb(q30min x4)
(Ipratroprium Br <5yrs – 0.25mg; >5yrs – 0.5mg mixed with N/S to 4ml)
Observation
Prednisolone (1-2mg/kg D) OR Hydrocortisone (2mg/kg q 6hr)
30min
Consider Adrenaline (0.01mg/kg max 0.3mg IMI)
IVI fluids (2/3 maintenance fluid)

Good response Refer Paeds

Observation
Yes PEFR > 75% ASAP
60min
SpO2>95%

Response?
(?ABG)

Repeat β Agonist Neb

Prednisolone (1-2mg/Kg)
Partial: Poor:
Good response PEFR 50-75% PEFR <50% SpO2<90%
PEFR > 75% SpO2 90-95% PaCO2>4.5kPa
SpO2>95% Observation PaO2 <8kPa
60min

Severe / Life Threatening - ICU

Good response Paeds Ward Nebs – β Agonist Continuously
PEFR > 75% β2 Agonist Neb (later q20min) Ipatroprium Bromide (q4hr)
SpO2>95% (Salbutamol neb <5yrs – 2.5mg; >5yrs – 5mg
CXR to exclude pneumothorax
mixed with N/S to 4ml)
FBC , U&E, ABG
DISCHARGE Yes Ipratroprium Bromide Neb(q30min x4)
Advice & TTO s (Ipratroprium Br <5yrs – 0.25mg; >5yrs – 0.5mg
IN DISCUSSION WITH PAEDS
NO mixed with N/S to 4ml)
Prednisolone (1-2mg/kg D) CONSULTANT
MgSO4 (50mg/kg IVI over 20min)
Refer Paeds CXR IVI β 2 Agonist (Salbut. 15mcg/kg over 15min)
Aminophylline (5mg/kg over 30min)

L Hodsdon / WH Paeds —2022

 WPH EC Cheat Sheet
Paediatric
Asthma
ASSESSMENT OF ACUTE ASTHMATIC EXACERBATIONS:

Mild Moderate Severe Life Threatening

PEFR >75% 50-75% <50% <33%
Talks / Feed Normal Words / Phrases Too breathless to feed / talk
RR < 5 years < 30 > 30 > 50 Variable
> 5 years < 25 > 25 > 30 Variable
Pulse < 5 years < 110 110 - 130 > 130 Variable
> 5 years < 100 100 - 120 > 120 Variable
Blood Pressure - - - Hypotension
Accessory Muscle Mild Usual Usual Absent - Fatigue
Wheeze Present Loud Usually Loud Silent Chest
SpO2 > 95% 91 - 95% <90% Variable
PaO2 > 8kPa > 8kPa < 8kPa Variable
PaCO2 < 6kPa < 6kPa > 6kPa > PaCO2
Cyanosis
Other Sxs - - -
↓ LOC / agitation

Oxygen
Nebulised B2–agonist: Always mix to 4mls with Normal Saline
Salbutamol 2,5mg (<5yrs) or 5mg (>5yrs)
Fenoterol 0.5mg (<5yrs) or 1mg (>5yrs)
Nebulised Ipratropium Bro- 0,25mg (<5yrs) or 0,5mg (>5yrs)
mide
Prednisone 1-2mg/kg/dose daily
Hydrocortisone 2mg/kg 6hrly (max 200mg) IVI

Magnesium sulphate 50% 50mg/kg over 20 mins IV (make up to a 10ml solution with normal saline)
IV Salbutamol Infusion: Loading Dose:
(1mg/ml ampule) 15 mcg/kg over 15 min
(0.015ml/kg; make up to a 10 ml solution with N/S)
Maintenance dose
(1–2mcg/kg/min)
0.06–0.12ml/kg/hr of above soln- Half dose if already on Aminophylline
L Hodsdon — 2022

NB: INCOMPATIBLE WITH AMINOPHYLLINE, KETAMINE, MAGNESIUM

Aminophylline Loading Dose:
5mg/kg over 30
Maintenance dose
0.5-1.0mg/kg/hr