Acute asthma in emergency room.
Acute asthmatic exacerbation is one of the commonest emergencies seen in the pediatric age group. Viral infections are the most important triggers which set up the inflammatory reaction in the bronchial mucosa. GINA 2002 guidelines for assessing the severity and management are very useful for day to day practice. There is evidence to support the view that metered dose inhaler alongwith spaceor with or without mask is as effective as the standard doses of beta-2 agonists given by nebulizer. Ipratrpium bromide adds to the benefits of short acting beta-2 agonists. Systemic steroids should be started early. Early introduction of l/v beta-2 agonists and trial of l/v magnesium sulfate in non-responders have been recently recommended. Intravenous aminophylline can be tried in addition to full dose beta-2 agonists in those who reach the PICU. A close watch on the patient by monitoring clinical parameters, pulse oximeter, arterial blood gases and peak flow rate help in deciding whether there is need to further step up the therapy. Non-conventional measures like ketamine should be tried only under constant monitoring.
Chugh
Krishan
K
Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India. chughk@bol.net.in
D000208:Acute Disease; D000280:Administration, Inhalation; D000284:Administration, Oral; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000628:Aminophylline / Q000627:therapeutic use; D001249:Asthma / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D004632:Emergency Medical Services / Q000379:methods*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D007267:Injections; D007649:Ketamine / Q000008:administration & dosage; D008278:Magnesium Sulfate / Q000008:administration & dosage; D009330:Nebulizers and Vaporizers; D012129:Respiratory Function Tests
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D000628:Aminophylline; D007649:Ketamine; D008278:Magnesium Sulfate