Diagnosis and Treatment of Asthma. Emergency Department or Inpatient Management Algorithm.

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Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of asthma. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Jan. 69 p. Diagnosis and Management of Asthma Emergency Department or Inpatient Management Algorithm Patient in ED or inpatient with asthma exacerbation Follow guideline through discharge #32 A = Annotation Assess severity of asthma exacerbation. A Impending or actual respiratory arrest? *Out of guideline. *Provide ventilatory support as needed. Initial treatment *Inhaled beta2-agonist via MDI or nebulizer. A Assess response to treatment *Interval assessment within 20 minutes. *PE including vitals, ausculation. *Symptoms. *FEV1 or PEF. *O2 saturation. *Other tests as indicated. Patient demonstrates good response. *FEV or PEF greater than 80%. *O2 saturation greater than 92%. *Minimal symptoms. Patient demonstrates incomplete response *FEV or PEF equals 50%-80%. *O2 saturation greater than 90%. *Mild to moderate symptoms. Patient demonstrates poor response. *FEV or PEF less than 50%. *O2 saturation less than 90%. *Moderate to severe symptoms. Treatment (incomplete response). *Inhaled beta2-agonist by MDI or nebulizer up to 3 doses per hour. *Initiate systemic corticosteroids. *Consider antichoinergic by MDI or nebulization. A Treatment (poor response). *Continuous or intermittent nebulization with inhaled beta2-agonist and anticholinergic by nebulization. *Initiate corticosteroid, oral or IV. *Consider bi-level PAP or other therapy. A Discharge home *Medication. *Asthma education. *Asthma action plan. *Follow-up. Repeat assessment of response of treatment. *Interval assessment within 20 minutes. *PE including vitals, ausculation. *PEV or PEF. *O2 saturation. Continue management in boxes #25 and 27 Admit to hospital? A Continue management in hospital. Discharge box #32. A All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.