ASTHMA IN CHILDREN: SEEKING MEDICAL ASSISTANCE – MANAGEMENT OF EMERGENCY TREATMENT – INITIAL TREATMENT

Posted by admin on December 18, 2010 under Asthma | Be the First to Comment

Initial treatment starts with selective beta-2 agonist salbutamol may be delivered by a nebulizer, usually with oxygen. Nebulized treatment is given every 20 minutes for one hour, and the child’s condition continuously assessed.
Theophylline is not given at this stage since it does not help much in bronchodilation, which in the first four hours of emergency medication is achieved with beta-2 agonists.
If the child shows a positive response to the initial treatment (PEFR > 70% predicted or personal best), the interval of beta-2 agonist treatment can be increased to every two hours; and child’s condition observed hourly. If after that time the child’s condition becomes stable he may be discharged after the parents are given instructions about the medication and follow-up plan.
If the child does not show signs of improvement after the first one hour of beta-2 agonist treatment (PEFR < 70% predicted or personal best), then oral or intravenous steroids have to be administered, and nebulized beta-2 agonist treatment given every 20 minutes for two hours. The child’s condition is continually assessed and a decision made after 2 hours whether the treatment should continue in the emergency department, or hospitalisation is necessary, or whether the child can be allowed to go home.
Even if a decision is taken to allow the child to go home, he should be kept under observation for another hour to see that there is continuous improvement in the condition.
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