Status Asthmaticus
Magnesium Sulfate for Acute Asthma Exacerbation
Intravenous magnesium sulfate given as a single dose of 1.2 g or 2 g over 15 to 30 minutes improves lung function and reduces the risk of hospital admission in adults with acute asthma exacerbations that have not resolved with current first line treatments.
Steroids for Acute Asthma Exacerbation
A single dose of oral dexamethasone 12mg may be a reasonable alternative to a 5-day course of prednisone 60mg for adults with asthma exacerbations.
Coke Bottle named Asthma
Metered-dose inhalers with a spacer can perform at least as well as nebulisation in delivering beta-agonists in children with acute asthma. Salbutamol has systemic side effects – tremor and increased pulse rate were more common when using nebulisers.
The Crashing Asthmatic
In severe life threatening asthma…adrenaline and magnesium helps your patient breath in the salbutamol…
Severe asthma life saving drugs (pediatric doses)
- hydrocortisone 100mg IV (3-5mg/kg)
- magnesium sulfate 2gm IV (50mg/kg) x 3 in the first hour
- adrenaline 0.5mg IM (0.01mg/kg (max 0.5mg))
Mild to Moderate Acute Asthma Attack…
Most DO NOT need a chest X-ray performed and a high WBC is common as a result both of stress as well as steroid use NOT A SIGN OF INFECTION so DON’T order labs or give antibiotics unless there are other features of infection.
Magnesium sulfate for moderate to severe asthma exacerbation
If inhaled salbutamol and iprotropium (remember, double nebs decrease the risk of admission) plus systemic glucocorticoids don’t help, give IV Magnesium sulfate 50 mg/kg IV over 20 minutes (max dose 2 grams, use this dose for adults)
Heroic Medical Measures in the Crashing Asthmatic
- Pre-oxygenate your patient with high flow nasal cannula at 20 – 30 LPM
- Next consider using IM Epinephrine 0.3 – 0.5mg of 1:1000. Severe asthmatics will have a hard time getting inhaled beta agonists into the small airways, but parenteral epinephrine will get into the circulation and get to where it needs to provide support.
- Non-Invasive Positive Pressure Ventilation (NIPPV)
- Corticosteroids
- 2g IV Magnesium and repeat it up to 2 more times over an hour
- Give IVF at a dose of 30cc/kg because patients with acute asthma exacerbations because patients will have insensible losses.
…and many more including intubating and ventilating the Crashing Asthmatic Patient…great read.