Asthma - Acute Paediatric - 5

Important: Accurate assessment of severity is crucial for appropriate management - ask for help if you are unsure   

Does the child need to be admitted to hospital ?

If the child still has a wheeze after 3 cycles of salbutamol treatment (inhaler / nebuliser) over one hour, they should be admitted.

This is a rule of thumb which has not been tested in a RCT, but has proved effective and safe.
If there is no wheeze, the child should be observed for another hour, and if stable, may go home.    

The very ill child

The very ill asthmatc is generally fairly easy to spot. The child looks tired, and blue (cyanosed) and may have a silent chest - moving very little air.

A child like this is likely to need intubation and ventilation, and should be immediately reviewed by someone capable of doing this.
Early consultant is vital so that intubation, if indicated, is elective and controlled, and not a rushed procedure done when the child has stopped breathing.    

If the child is to be sent home

The child needs to have an asthma management plan.
There are many different varieties of these, but this is    

Link Asthma action plans