Pediatric Status Asthmaticus

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Brief HPI:

A 6 year-old boy with a history of asthma presents to the emergency department via EMS for dyspnea. The patient is agitated on exam with nasal flaring and intercostal retractions. The parents report that his difficulty breathing started two days ago. The first day his MDI inhaler provided transient relief; however, over the next 24 hours he required nebulized albuterol 3 times with no significant relief. They deny any recent infections or steroid use and state that his immunizations are up-to-date.

On evaluation, vital signs are notable for BP 93/61, HR 140, RR 47, and SpO2 90%. He is afebrile; capillary glucose 113mg/dL. On examination, the patient is agitated with nasal flaring, intercostal retractions, shallow breathing with diminished breath sounds throughout.

Algorithm for the Management of Pediatric Asthma1-11

Algorithm for the Management of Pediatric Asthma

PASS12

Wheezing Work of Breathing Prolonged Expiration
Mild (0) None or end-expiration Normal or minimal retractions Normal or minimally prolonged
Moderate (1) Throughout expiration Intercostal retractions Moderately prolonged
Severe (2) Severe wheezing or absent Suprasternal retractions, abdominal wall movement Severely prolonged
This algorithm was developed by Dr. Joshua Niforatos. Joshua is an emergency medicine resident at The Johns Hopkins School of Medicine and an alumnus of the Cleveland Clinic Lerner College of Medicine.

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Special thanks to Dr. Kelly Young, Director of the Pediatric Emergency Medicine Fellowship at Harbor-UCLA Medical Center and Dr. Adeola Kosoko, Assistant Professor, Assistant Residency Program Director, Director Of Diversity, Inclusion, And Mission at McGovern Medical School for their review of the algorithm.

References

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