asthma/wheeze management plan - enhertsccg.nhs.uk · asthma/wheeze management plan • this is your...

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Asthma/wheeze management plan This is your child’s discharge plan and treatment until their next review. Make an appointment with a GP or asthma nurse within 48hrs of discharge Symptoms of asthma include: Cough, wheeze, shortness of breath, chest tightness that may cause difficulty in speaking or feeding. Not everyone with asthma will wheeze Please note how much treatment your child is requiring and how this helps When asthma is fully controlled your child should be symptom free and not require any reliever inhaler (salbutamol.) Preventer medication should be used even when well Out of hours call 111 Treatment Medication When to use Name and strength of medication No. of puffs/dose Times per day Reliever inhaler usually Salbutamol and blue Use when your child is coughing or wheezing or their chest feels tight. Preventer inhaler Often brown, orange or purple Your child should use their ( ) inhaler every day even when well Prednisolone (steroids) Short course when unwell, usually 3-5 days Preventer tablet or granules. Use every day Use every day Other treatments: Remember Your child should use their Preventer inhaler ( ) every morning and evening and only stop if their doctor or asthma nurse tells them to. Salbutamol is a reliever. When you child is well they will not need to use this at all Keep a salbutamol inhaler with you at all times. Start salbutamol as soon as your child gets symptoms and continue until symptoms have resolved. Using salbutamol Give 2 puffs. I puff at a time, wait for 2 minutes and assess the response, repeat if necessary continuing up to 10 puffs. If your child does not respond to 10 puffs call 999 & repeat If your child needs to use their blue inhaler more often than every 4 hours you should take them to see their doctor or use the out of hours services. (Call 111) If your child repeatedly needs doses of 6-10 puffs every 4 hours you should take them to see their doctor or use the out of hours services. (Call 111) they are likely to need a course of steroids Name of Patient Date of Birth NHS Number GP surgery Telephone Next appointment Children’s Assessment unit/ward telephone Open access Y/N Until date Some areas may instruct you to take your child to the Children’s Emergency Department. Make sure you know what to do in your area

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Page 1: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

Asthma/wheeze management plan

• This is your child’s discharge plan and treatment until their next review.

• Make an appointment with a GP or asthma nurse within 48hrs of discharge

• Symptoms of asthma include: Cough, wheeze, shortness of breath, chest tightness that may cause

difficulty in speaking or feeding. Not everyone with asthma will wheeze

• Please note how much treatment your child is requiring and how this helps

• When asthma is fully controlled your child should be symptom free and not require any reliever

inhaler (salbutamol.)

• Preventer medication should be used even when well

Out of hours call 111

Treatment

Medication When to use Name and strength

of medication

No. of puffs/dose Times per day

Reliever inhaler

usually Salbutamol

and blue

Use when your child is

coughing or wheezing or

their chest feels tight.

Preventer inhaler

Often brown,

orange or purple

Your child should use

their ( ) inhaler

every day

even when well

Prednisolone

(steroids)

Short course when

unwell, usually 3-5 days

Preventer tablet or

granules. Use

every day

Use every day

Other treatments:

Remember • Your child should use their Preventer inhaler ( ) every morning and evening and only stop

if their doctor or asthma nurse tells them to.

• Salbutamol is a reliever. When you child is well they will not need to use this at all

• Keep a salbutamol inhaler with you at all times.

• Start salbutamol as soon as your child gets symptoms and continue until symptoms have resolved.

Using salbutamol • Give 2 puffs. I puff at a time, wait for 2 minutes and assess the response, repeat if necessary continuing

up to 10 puffs.

• If your child does not respond to 10 puffs call 999 & repeat

• If your child needs to use their blue inhaler more often than every 4 hours you should take them to see

their doctor or use the out of hours services. (Call 111)

• If your child repeatedly needs doses of 6-10 puffs every 4 hours you should take them to see their doctor

or use the out of hours services. (Call 111) they are likely to need a course of steroids

Name of Patient Date of Birth NHS Number

GP surgery Telephone Next appointment

Children’s Assessment unit/ward telephone

Open access Y/N Until date

Some areas may instruct you to take your child to the Children’s Emergency

Department. Make sure you know what to do in your area

Page 2: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

For more information about asthma http://www.asthma.org.uk T 0800 1216244 Smoking, even outside can affect your child’s health & asthma. Ask at your

surgery for help to quit. For more information www.smokefree.nhs.uk

Life

threatening

If your child is: • Drowsy • Has a severe wheeze • Is unable to speak in sentences • Is unable to respond

Ring 999 You need immediate help Give 2 puffs (1 at a time) every 2 minutes of

salbutamol via a spacer until the ambulance arrives

Severe

If your child is: • Frightened • Breathless with a heaving chest • Unable to speak in sentences/take fluids and is

getting tired

Ring 999 You need immediate help Give 2 puffs (1 at a time) every 2 minutes of

salbutamol via a spacer until the ambulance arrives

Moderate

If your child is: • Wheezing and breathless and not responding

to usual reliever treatment Monitor your child closely and look for signs to see if they are getting worse

Contact your GP to make an appointment for your child to be seen immediately. Out of hours call 111 Continue to give salbutamol as described earlier

Mild

If your child is: • Requiring their reliever regularly throughout the

day/night for cough or wheeze but is not

working hard with their breathing and is able to continue day to day activities

Arrange an appointment to see your GP as soon a

possible/preferably the same day or call 111 if it is out of hours Continue to give salbutamol as described earlier and watch them closely

1. Remove the cap.

2. Attach the mask to the spacer

mouthpiece.

3. Shake the inhaler and insert into back of

spacer.

4. Tip the spacer to an angle of 45° or

more to allow the valve to remain open.

5. Place the mask over the mouth and

nose of the child to ensure there is a

good seal.

6. Press the inhaler canister and keep the

mask on the child’s face for 5 breaths.

7. Remove the mask from the child’s face.

8. For a further dose wait 30 seconds and

repeat steps 3 to 7.

How to use an

MDI with a small

volume spacer

and mask –

(spacer may be

yellow, orange or

blue.)

1. Remove the cap from the inhaler. Shake

the inhaler and insert into the back of the

spacer.

2. Place the mask of the spacer over the

mouth and nose of the child and ensure

there is a good seal.

3. Keeping the spacer level press the

inhaler canister.

4. Encourage the child to breathe in and

out slowly and gently for 5 breaths, (if

you hear a whistling sound they are

breathing in to quickly).

5. Remove the mask from the child’s face.

6. If taking another dose, wait 30 seconds

and repeat steps 1-4. Replace

mouthpiece cover after use.

1. Remove caps from the inhaler and

spacer. Shake the inhaler and insert into

the back of the spacer.

2. Breathe out gently as far as is

comfortable. Put the mouthpiece of the

spacer into your mouth and seal your

lips around it.

3. Press the canister once to release a

dose of medicine. Breathe in slowly and

steadily (if you hear a whistling sound

you are breathing in too quickly).

4. Remove spacer from your mouth and

hold your breath for 10 seconds, or as

long as is possible, then breathe out

slowly.

5. If taking another dose, wait for 30

seconds and repeat steps 1-4. Replace

the mouthpiece covers after use.

How to use an

MDI with a small

volume spacer

How to use an

MDI with a large

volume spacer

and mask for

infant/small

child

Get help day or night. Do not worry about making a fuss

Medications reviewed by

Name: Signature:: Date

Copy of this plan sent to GP

Name: Signature:: Date

Information/education received by:

Name: Signature:: Date

Inhaler technique checked by

Name: Signature:: Date

Not all types of inhaler are shown here. Ask the doctor or nurse if you are unsure how to use the inhalers you have been given.

The type of inhaler and spacer with or without a mask you are given will depend on your child. For more information see http://www.asthma.org.uk/Sites/healthcare-professionals/pages/inhaler-demos

Page 3: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

Management of Acute Exacerbation of Asthma / Wheeze

Primary Care Clinical Assessment Tool for Children Under 2 Years

History

• Breathless/wheeze/cough

• Viral or allergic trigger

• Previous episodes or interval symptoms

• FH or personal history asthma, eczema or atopy

• Current/Previous treatment and response

Consider other diagnosis • Pneumonia

• Bronchiolitis in under 1yr old

• Croup

• Foreign body

No – treat as below

It may not be asthma. Seek expert help Yes

Treat according to most severe feature

Moderate

• Able to feed or talk

• Moderate use of accessory

muscles

• Audible wheeze

• Sats>92% in air

<1 year

• RR<40/min HR 120-170/min

1-2 yrs

• R<35/min HR 80-110/min

• Give salbutamol 2-10 puffs via

spacer+facemask (one puff at a

time.)

• Increase by 2 puffs every 2

minutes up to 10 puffs according

to response

• Assess response and repeat if

necessary

• Give stat dose soluble

prednisolone 10mg

• Call 999

• Give high flow oxygen via fitted

mask aim for Sats 94-98%

• Give nebulised Salbutamol 2.5mg

(using 6L-8L oxygen)

• Reassess and repeat at 20-30

minute intervals or as necessary

• Give stat dose soluble

Prednisolone 10mg

• Consider nebulised Ipratropium

Bromide 250mcg (using 6L-8L

oxygen). Repeat every 20-30

minutes

• Commence resuscitation

• Call 999

• Give high flow Oxygen via fitted

mask

• Give back to back nebulised

Salbutamol 2.5mg (using 6L-8L

oxygen)

• Give stat dose soluble

Prednisolone 10mg

• Give nebulised Ipratropium

Bromide 250mcg (using 6L-8L

oxygen). Repeat every 20-30

minutes

Ensure a health professional stays with child

Contact duty paediatric registrar or consultant to arrange admission

Severe

• Previous attack within last 2 weeks

• Too breathless to feed or talk

• Marked use of accessory muscles

and wheeze

• Sats< 92 % in air

<1 yr:

• RR >40/min HR>170/min

1- 2yrs:

• RR >35/min HR >110/min

Life Threatening

• Sats <92% in air plus any of the

following:

• Silent chest

• Poor respiratory effort

• Exhausted and unresponsive

• Coma/agitation

• Cyanosis

• Bradycardia

• Apnoea

• Respiratory arrest

Examination

• Feeding and speech

• Respiratory rate

• Chest wall expansion and movement

• Use of accessory muscles

• Auscultation of chest – reduced air entry,

wheeze, prolonged expiration

• Oxygen Saturation (Sats)

Good response

• Reassess

within 1 hour

• Subtle or no

use of

accessory

muscles

• Minimum

wheeze

• Sats >92% in

air

Assessment

Poor

Response

Reconsider

diagnosis or

severe & life

threatening

episode

Ambulance transfer pathway

Continue to administer oxygen driven nebulised salbutamol if symptoms are

severe whilst transferring the child to the emergency department

Page 4: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

Patient must be stable have minimal recession with Sats >92% and manage 3-4 hourly between doses of inhaler

• Discharge on salbutamol 2-10 puffs up to 4 hourly via spacer + facemask

• Complete a 3 day course of Prednisolone 10mg or 2mg/kg/dose

• Give acute asthma management plan

• Check inhaler technique and regular medication

• Review overall asthma control and consider need to step up medication

Arrange a review at GP practice within 48 hours and give advice on re-accessing medical care if condition worsens e.g.

OOH service (or open access to Children’s Assessment unit if an option.)

Full Respiratory assessment in 7-14 days in primary care

THINK TTT –

consider compliance with existing Therapy, Inhaler Technique and Triggers before stepping up treatment

Ref: The British Thoracic Society (BTS) and SIGN Guideline on the Management of Asthma (Revised Jan 2012) and

thanks to The Suffolk Respiratory Pathway Group

July 2013

Discharge from hospital and GP

Page 5: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

Ensure a health professional stays with child

Contact duty paediatric registrar or consultant to arrange admission

Management of Acute Exacerbation of Asthma / Wheeze

Primary Care Clinical Assessment Tool for Children Over 2 Years

History

• Breathless/wheeze/cough/chest tightness

• Viral or allergic trigger

• Previous episodes or interval symptoms

• Family or personal history asthma, eczema

or atopy

• Current/Previous treatment and responses

Consider other diagnosis

• Pneumonia

• Bronchiolitis in under 1yr old

• Croup

• Foreign body

No – treat as below

It may not be asthma. Seek expert help Yes

Treat according to most severe feature

Moderate Exacerbation

• Able to talk

• Moderate respiratory

distress/wheeze

• Sats ≥92%

• PEF >50% predicted or best (>5yrs)

2-5 yrs:

• RR ≤40/min HR ≤ 140/min

5-12yrs:

• RR ≤30/min HR ≤ 125/min

12-18yrs:

• RR <25/min HR ≤ 110/mn

• Give Salbutamol 2-10 puffs via

spacer+facemask (one puff at a

time.)

• Increase by 2 puffs every 2

minutes up to 10 puffs according

to response

• Assess response and repeat if

necessary

• Give stat dose soluble

Prednisolone 20mg

• 2-5yrs and 30-40 mg > 5yrs or

2mg/Kg dose (maximum 40mg)

• Call 999

• Give high flow oxygen via fitted

face mask aim for Sats 94-98%

• Give nebulised Salbutamol (using

6L-8L oxygen):<5yrs 2.5mg and

• > 5yrs 5mg

• Reassess and Repeat at 20-

30min intervals or as necessary

• Give stat dose soluble

Prednisolone 20mg 2-5yrs and

30-40 mg > 5yrs or 2mg/Kg dose

(maximum 40mg)

• Consider nebulised Ipratropium

Bromide (using 6L oxygen):

<12yrs 250mcg;12-18yrs 500mcg

repeated every 20-30 minutes

• Commence resuscitation - ABC

• Call 999

• Give high flow oxygen via fitted

facemask

• Give back to back nebulised

Salbutamol (using 6L- 8L oxygen):

<5yrs 2.5mg; >5yrs 5mg

• Give stat dose soluble

Prednisolone 20mg 2-5yrs and

30-40 mg > 5yrs or 2mg/Kg dose

(maximum 40mg)

• Give nebulised Ipratropium

Bromide (using 6L oxygen):

<12yrs 250mcg;

• 12-18yrs 500mcg repeated every

20-30 mins

Severe

• Previous attack within last 2 weeks

• Too breathless to talk or complete

sentence

• Marked respiratory distress/wheeze

• Sats <92%

• PEF 33- 50% predicted or best

2-5yrs

• RR>40/min HR > 140/min

5-12yrs

• RR>30/min HR > 125/min

12-18yrs

• RR≥25/min HR >110/min

Life Threatening

• Sats <92% plus any of the

following:

• Silent chest

• Poor respiratory effort

• Exhausted and unresponsive

• Confusion/coma/agitation

• Cyanosis

• Bradycardia

• Respiratory arrest

• PEF not recordable or <33%

predicted or best

Examination

• Speech

• Respiratory rate

• Chest wall expansion and movement

• Use of accessory muscles

• Auscultation of chest – reduced air entry, wheeze, prolonged

expiration

• Oxygen Saturation (Sats)

• Peak flow measurement (>5yrs but often unreliable in younger age)

Good response

Reassess within

1 hour

• Subtle or no use

of accessory

muscles

• Minimum wheeze

• Sats >92% in air

• Rising PEF in

>5 yrs

Assessment

Poor

Response

Reconsider

diagnosis or

severe & life

threatening

episode

Ambulance transfer pathway

Continue to administer oxygen driven nebulised salbutamol if symptoms are

severe whilst transferring the child to the emergency department

Page 6: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

Patient must be stable have minimal recession with Sats >92% and manage 3-4 hourly between doses of inhaler

• Discharge on salbutamol 2-10 puffs up to 4 hourly via spacer + facemask

• Complete a 3 day course of Prednisolone; child < 5 yrs 20mg; 5-12 yrs 30-40mg for 3 days; 12-18 yrs 40mg for 3- 5

days(or 2mg/kg dose up to 40mg )

• Give Acute Asthma Management Plan

• Check inhaler technique and regular medication

• Review overall asthma control and consider need to step up medication

• Arrange a review at GP practice within 48 hours and give advice on re-accessing medical care if condition worsens

e.g. OOH service (or open access to Children’s Assessment Unit if an option.)

Full Respiratory assessment in 7-14 days in primary care

THINK TTT –

consider compliance with existing Therapy, Inhaler Technique and Triggers before stepping up treatment

Ref: The British Thoracic Society (BTS) and SIGN Guideline on the Management of Asthma (Revised Jan 2012) and

thanks to The Suffolk Respiratory Pathway Group

Discharge from hospital and GP

Respiratory Rate at Rest:

<2-5yrs 25-30 breaths/min

5-12yrs 20-25 breaths/min

>12yrs 15-20 breaths/min

Heart Rate

<2-5yrs 95-140 bpm

5-12yrs 80-120 bpm

>12yrs 60-100 bpm

Height (m) Height (ft) Predicted EU PEFR (L/min)

0.85 2’9” 87

0.90 2’11” 95

0.95 3’1” 104

1.00 3’3” 115

1.05 3’5” 127

1.10 3’7” 141

1.15 3’9” 157

1.20 3’11” 174

1.25 4’1” 192

1.30 4’3” 212

1.35 4’5” 233

1.40 4’7” 254

1.45 4’9” 276

1.50 4’11” 299

1.55 5’1” 323

1.60 5’3” 346

1.65 5’5” 370

1.70 5’7” 393

Table 2: Predicted Peak flow: for use with EU/EN13826 scale PEF

metres only

Table 1: Normal Paediatric Values

Page 7: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

Management of Acute Exacerbation of Asthma / Wheeze

Secondary Care Clinical Assessment Tool for Children Under 2 Years

History

• Breathless/wheeze/cough

• Viral or allergic trigger

• Previous episodes or interval symptoms

• FH or personal history asthma, eczema or

atopy

• Current/Previous treatment and response

Consider other diagnosis

• Pneumonia

• Bronchiolitis in under 1yr old

• Croup

• Foreign body

No – treat as below

It may not be asthma. Seek expert help Yes

Treat according to most severe feature

Moderate Exacerbation

• Able to feed or talk

• Moderate use of accessory

muscles

• Audible wheeze

• Sats >92% in air

< 1 yr:

• RR ≤40/min HR 120-170/min

1-2yrs:

• RR ≤35/min HR 80-110/min

• Give Salbutamol 2-10 puffs

via spacer+facemask (one

puff at a time.

• Increase by 2 puffs every

2 minutes up to 10 puffs

according to response

• Assess response and repeat

if necessary

• Give stat dose soluble

Prednisolone 10mg

• Give high flow Oxygen via fitted

mask aim for sats 94-98%

• Give nebulised Salbutamol 2.5mg

(using 6L-8L oxygen)

• Reassess and Repeat at 20-30

minute intervals or as necessary

• Give stat dose soluble Prednisolone

10mg

• Repeat dose if patient vomits, or

consider IV Hydrocortisone 4mg/Kg

• If Poor response Ipatropium

Bromide 250 micrograms via

oxygen driven nebuliser repeated

every 20-30minutes

• Poor response see life-threatening

• Discuss with senior clinician or

Paediatrician or PICU team

• Commence resuscitation -

ABC

• Give high flow Oxygen via

mask

PAEDIATRIC CARDIAC

ARREST CALL

• Give back to back nebulised

Salbutamol 2.5mg (using 6L-

8L oxygen)

• Give stat dose soluble

Prednisolone 10mg

• Repeat dose if patient vomits,

or consider IV Hydrocortisone

4mg/Kg

• Give nebulised Ipratropium

Bromide 250mcg (using 6L-

8L oxygen). Repeat every 20-

30 minutes

POOR RESPONSE

• Consider IV Salbutamol and

Magnesium

• Consider Chest X-Ray

• Arrange PICU/ITU admission

Severe

• Previous attack within last 2 weeks

• Too breathless to feed or talk

• Marked use of accessory muscles

and wheeze

• Sats< 92 % in air

• <1 yr:

• RR >40/min HR>170/min

• 1- 2yrs:

• RR >35/min HR >110/min

Life Threatening

• Sats <92% in air plus any of the

following:

• Silent chest

• Poor respiratory effort

• Exhausted and unresponsive

• Coma/agitation

• Cyanosis

• Bradycardia

• Apnoea

• Respiratory arrest

Examination

• Feeding and speech

• Respiratory rate

• Chest wall expansion and movement

• Use of accessory muscles

• Auscultation of chest – reduced air entry,

wheeze, prolonged expiration

• Oxygen Saturation (Sats)

Good response

Reassess within 1 hour

• Subtle or no use of accessory

muscles

• Minimum wheeze

• Sats >92% in air

Assessment

Poor Response

Reconsider diagnosis: Severe or

Life Threatening episode

Admit/further

observation on

Children’s

Assessment unit for

all cases if severe

symptoms after

initial treatment

Good

response

Continue

salbutamol

1-4 hourly

Re-Assess

regularly

Page 8: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

Patient must be stable have minimal recession with Sats >92% and manage 3-4 hourly between doses of inhaler

• Discharge on salbutamol 2-10 puffs up to 4 hourly via spacer + facemask

• Complete a 3 day course of Prednisolone10 mg or 2mg/kg/dose

• Give Acute Asthma Management Plan

• Check inhaler technique and regular medication

• Review overall asthma control and consider need to step up medication

• Arrange review at GP practise 48hrs

• Open access to Children’s Assessment Unit for 48hours

• Full respiratory review at GP practise in 7-14 days

• Arrange FU in clinic with Asthma Consultant/nurse

THINK TTT –

consider compliance with existing Therapy, Inhaler Technique and Triggers before stepping up treatment

Ref: The British Thoracic Society (BTS) and SIGN Guideline on the Management of Asthma (Revised Jan 2012) and

thanks to The Suffolk Respiratory Pathway Group.

July 2013

Discharge from hospital and GP

Page 9: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

Management of Acute Exacerbation of Asthma / Wheeze

Secondary Care Clinical Assessment Tool for Children Over 2 Years

History

• Breathless/wheeze/cough/chest tightness

• Viral or allergic trigger

• Previous episodes or interval symptoms

• Family or personal history asthma, eczema

or atopy

• Current/Previous treatment and responses

Consider other diagnosis

• Pneumonia

• Croup

• Foreign body

• Hyperventilation/panic attack

No – treat as below

It may not be asthma. Seek expert help Yes

Treat according to most severe feature

Moderate Exacerbation

• Able to talk

• Moderate respiratory

distress/wheeze

• Oxygen Sats ≥92%

• PEF >50% predicted or best (>5yrs)

2-5 yrs:

• RR ≤40/min HR ≤ 140/min

5-12yrs:

• RR ≤30/min HR ≤ 125/min

12-18yrs:

• RR <25/min HR ≤ 110/mn

• Give Salbutamol 2-10 puffs via

spacer+facemask (given one at a

time)

• Increase by 2 puffs every 2

minutes up to 10 puffs according

to response

• Assess response and repeat if

necessary

• Give stat dose soluble

Prednisolone 20mg

• 2-5yrs and 30-40 mg > 5yrs or

2mg/Kg dose (maximum 40mg)

• Give high flow oxygen via fitted face

mask aim for Sats 94-98%

• Give nebulised Salbutamol (using 6L

oxygen). <5yrs 2.5mg and > 5yrs 5mg

• Reassess and Repeat at 20-30min

intervals or as necessary

• Give stat dose soluble Prednisolone

20mg 2-5yrs and 30-40 mg > 5yrs or

2mg/Kg dose (maximum 40mg)

• Or IV Hydrocortisone 4mg/Kg

• If poor response nebulised Ipratropium

Bromide (using 6L oxygen): <12yrs

250mcg;12-18yrs 500mcg repeated

every 20-30 minutes

• Poor response see life-threatening

Discuss with senior clinician or

Paediatrician or PICU team

• Commence resuscitation - ABC

• Give high flow oxygen via a facemask

to achieve Sp0₂ 94-98%

PAEDIATRIC CARDIAC ARREST CALL

Give back to back nebulised Salbutamol

(using 6L-8L oxygen). <5yrs 2.5mg,

>5yrs 5mg

• Give oral prednisolone 20mg 2-5yrs

and 30-40 mg > 5yrs or 2mg/Kg dose

(maximum 40mg)

• Or Hydrocortisone 4mg/Kg

• Give nebulised Ipratropium Bromide

(using 6L-8L oxygen). <12yrs 250mcg

12-18yrs 500mcg repeated every 20-

30 minutes

POOR RESPONSE

Ensure consultant paediatrician present

IV Salbutamol 15mcg/Kg bolus over 10

minutes followed by continuous infusion

1-5mcg/Kg/min (dilute to 200mcg/ml)

IV Aminophylline 5mg/Kg loading dose

over 20 minutes followed by continuous

infusion 1 mg/Kg/hour

Bolus IV infusion of Magnesium

Sulphate 40mg/Kg (max 2g) over 20

mins

Consider CXR and blood gases

Arrange PICU/HDU admission

Severe

• Previous attack within last 2 weeks

• Too breathless to talk or complete

sentence

• Marked respiratory distress/wheeze

• Sats <92%

• PEF 33- 50% predicted or best

2-5yrs

• RR>40/min HR > 140/min

5-12yrs

• RR>30/min HR > 125/min

12-18yrs

• RR≥25/min HR >110/min

Life Threatening

• Oxygen sats <92% plus any of

the following:

• Silent chest

• Poor respiratory effort

• Exhausted and unresponsive

• Confusion/coma/agitation

• Cyanosis

• Bradycardia

• Respiratory arrest

• PEF not recordable or <33%

predicted or best

Examination

• Able to speak in sentences

• Respiratory rate

• Chest wall expansion and movement

• Use of accessory muscles

• Auscultation of chest – reduced air entry, wheeze, prolonged

expiration

• Oxygen Saturation

• Peak flow measurement (>5yrs but often unreliable in younger age)

Good response

Reassess within

1 hour

• Subtle or no use

of accessory

muscles

• Minimum wheeze

• Sats >92% in air

• Rising PEF in

>5 yrs

Assessment

Poor

Response

Reconsider

diagnosis:

Severe or

Life

Threatening

episode

Admit/further

observation on

Children’s

Assessment unit for

all cases if severe

symptoms after

initial treatment

Good

response

Continue

salbutamol 1-

4 hourly

Re-Assess

regularly

Page 10: Asthma/wheeze management plan - enhertsccg.nhs.uk · Asthma/wheeze management plan • This is your child’s discharge plan and treatment until their next review. • Make an appointment

Patient must be stable have minimal recession with Sats >92% and manage 3-4 hourly between doses of inhaler

• Discharge on salbutamol 2-10 puffs up to 4 hourly via spacer + facemask

• Complete a 3 day course of Prednisolone; child < 5 yrs 20mg; 5-12 yrs 30-40mg for 3 days; 12-18 yrs 40mg for 3- 5

days(or 2mg/kg dose up to 40mg )

• Give acute asthma management plan

• Check inhaler technique and regular medication

• Review overall asthma control and consider need to step up medication

• Arrange a review at GP practice within 48 hrs

• Open access to Children’s Assessment Unit for 48hours

• Full respiratory review at GP practise in 7-14 days

• Arrange FU in clinic with Asthma Consultant/nurse

THINK TTT –

consider compliance with existing Therapy, Inhaler Technique and Triggers before stepping up treatment

Ref: The British Thoracic Society (BTS) and SIGN Guideline on the Management of Asthma (Revised Jan 2012) and

thanks to The Suffolk Respiratory Pathway Group

July 2013

Discharge from hospital and GP

Respiratory Rate at Rest:

<2-5yrs 25-30 breaths/min

5-12yrs 20-25 breaths/min

>12yrs 15-20 breaths/min

Heart Rate

<2-5yrs 95-140 bpm

5-12yrs 80-120 bpm

>12yrs 60-100 bpm

Systolic Blood Pressure

<2-5yrs 80-100 mmhg

5-12yrs 90-110 mmhg

>12yrs 100-120 mmhg

Height (m) Height (ft) Predicted EU PEFR (L/min)

0.85 2’9” 87

0.90 2’11” 95

0.95 3’1” 104

1.00 3’3” 115

1.05 3’5” 127

1.10 3’7” 141

1.15 3’9” 157

1.20 3’11” 174

1.25 4’1” 192

1.30 4’3” 212

1.35 4’5” 233

1.40 4’7” 254

1.45 4’9” 276

1.50 4’11” 299

1.55 5’1” 323

1.60 5’3” 346

1.65 5’5” 370

1.70 5’7” 393

Table 2: Predicted Peak flow: for use with EU/EN13826 scale PEF Table 1: Normal Paediatric Values

metres only