Wheeze severity assessment
MILD AND
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MODERATE AND
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SEVERE AND
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LIFE THREATENING AND
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'Red Flag features
- Has the patient previously received IV therapy for wheeze management?
- Has the patient been admitted to the PICU previously for respiratory illness?
If YES to any of the above then patient should be discussed with on call Paediatric Registrar prior to discharge.
Drugs
Salbutamol MDI + Spacer – Initial therapy = 10 puffs. (100mcg per puff)
Oxygen – minimum 6 l/min via non-rebreather mask
Prednisolone |
2 -4yrs 20mg OD >5yrs 40mg OD |
Nebulised medication for Severe Wheeze | |
2 -4yrs |
Salbutamol 2.5mg |
>5yrs |
Salbutamol 5mg |
IV MEDICATION
(To be prescribed as per the Escalation to IV therapy care pathway)
1. Magnesium sulphate injection |
40mg/kg over 20 minutes (max 2gram) |
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2. Aminophylline |
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3. Salbutamol |
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- Hydrocortisone - Ondansetron |
4mg/kg QDS (max 100mg) 100micrograms/kg (max 4mg) |
Discharge criteria & checklist
- Patient maintaining saturations > 94% in air
- Tolerating 3hrly multidosing
Patients with MILD asthma at 1st assessment can be discharged after Salbutamol without being monitored for 4 hours
- Discharge Checklist Completed
- No red flag features
- If presenting with interval symptoms medication reviewed and consideration given to starting Clenil Modulite 100mcg BD
- Follow-Up arranged as below
DISCHARGE PLANNING – POINTS TO CONSIDER |
Criteria for Acute Medical Paediatric Follow Up |
Discharge Checklist Completed? All the following must be completed prior to discharge
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GP’s should be able to manage the majority of children with wheeze Patients who have been started on a clenil inhaler should be advised to attend their G.P. in 6 weeks to assess response. Children where there is diagnostic uncertainty or very young children (between the ages of 2 and 3) with concern about recurrent presentations then discuss Follow up planning with either the general paediatrician or senior paediatric registrar on tel: 84678. |
CHRONIC FEATURES / INTERVAL SYMPTOMS |
Criteria for Respiratory Team Follow Up |
If any of the following features:
AND not on a Preventer inhaler then prescribe Clenil modulite 100mcg BD If already on a preventive inhaler review compliance and |
Any child requiring intravenous therapy for wheeze. Patients who have required intravenous therapy for wheeze should be monitored in hospital for at least 24 hours post the discontinuation of all intravenous therapy. Any child where there is a concern that they have failed to respond to significant asthma treatment. ALL RESPIRATORY REFERRALS SHOULD BE DISCUSSED WITH RESPIRATORY TEAM PRIOR TO PATIENT DISCHARGE FROM HOSPITAL. |