> 1. Nebulise continuously until patient either begins to improve or gets too
> exhausted or intubated for another reason?
> 2. Give IV Aminophylline (assume not had it before)?
> 3. Use IV Salbutamol to get some into the system despite him not moving any
> resps?
> 4. Use IV/S-cut Epi for same reason as 3.?
Assuming this is a poll of opinion:
Definitely keep the salbutamol nebuliser going continuously.
IV Salbutamol at a starting rate of 10 micrograms per minute (range 5 to 25).
Don't like the IV aminophylline but will use as third line if get a clear
history about oral theophylline use (or none use!)
Consider a magnesium bolus.
Then it's ketamine for induction and an intubation.
With experience in Australia, I have become a convert to earlier IV
salbutamol. Continuing use mandates an HDU level of nursing support as a
minimum.
References:
British Thoracic Society BMJ 1993;306:776-782: Guidelines for the management
of asthma: a summary.
Chart 3 specifically states 250 micrograms IV salbutamol over 10 minutes
OR IV aminophylline 250mg over 20 minutes.
Browne GJ, Penna AS, Phung X, Soo M: Randomised trial of intravenous
salbutamol in early management of acute severe asthma in children. Lancet
1997;349:301-305
And just something to tickle the brain cells:
Ciarallo L, Sauer AH, Shannon MW: Intravenous magnesium therapy for moderate
to severe paediatric asthma; Results of a randomised, placebo-controlled
trial. J Pediatr 1996;129:809-814
Best wishes
Darren
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