Common Emergency Respiratory Conditions

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BRONCHIOLITIS

Supportive treatment

  • Oxygen
  • If severe respiratory distress, commence CPAP
  • Regular suctioning
  • Feeding support

Note: There is no need for antibiotics 

 

ACUTE EXACERBATION OF ASTHMA

CLINICAL FEATURES

Severity of asthma are categorized as follows.

Mild: Audible wheeze, no respiratory distress, feeding well, O2 Saturation >92% 

Moderate: Respiratory distress, use of accessory muscles, still feeding well, Saturation >92%

Severe: Marked respiratory distress, too breathless to talk/feed, RR>30 if 5 years and >50 if 2-5 years, Saturation<92%

 

TREATMENT

NB: if inhalers and spacers cannot be obtained start with nebulized salbutamol at below mentioned doses and switch to inhaler later.

Mild Asthma

  • Salbutamol inhaler via spacer 2 puffs q6h for 2-3 days
  • Discharge with advice on inhaler and spacer technique

Moderate Asthma

  • Salbutamol inhaler via spacer; <4y- 5puffs every 20mins x3, >4yrs- 10puffs every 20mins x3
  • Prednisolone 1mg/kg (max 30mg q24h) for 3/7

Severe Asthma

  • Oxygen at 1-2 L/min over nasal prongs and at least 5 L/min over face mask
  • Salbutamol nebulizer (start with 3 back-to-back to start with)
    • <4yrs: 2.5mg
    • >4yrs: 5mg
  • Start steroids if no improvement but still continue Nebulizer
  • STEROIDS
    • Prednisolone 1-2mg/kg PO STAT- (Max. dose 40mg) OR 
    • Dexamethasone 0.6mg/kg PO STAT – (max. dose 10mg) OR
    • Hydrocortisone IV <5yrs: 50mg; >5yrs:100mg IV STAT
  • If no improvement continue Nebulizer but start IV therapy;
  • Magnesium Sulphate IV 40mg/kg (diluted to at least 10%) over 20 min OR
  • With caution use Aminophylline IV 5mg/kg (max. 300mg) diluted (maximum concentration 25mg/ml) and administered over 20min (maximum rate should not exceed 25mg/min)

SEVERE PNEUMONIA

Oxygen (2L/min to start)

Antibiotics

In children

  • Benzyl penicillin 50,000 IU/kg IV/IM q6h for 5 to 7 days
  • Gentamicin 7.5 mg/kg IM/IV q24h for 5 to 7 days
  • if improving switch to Amoxicillin 40mg/kg PO q12h x 5 days
  • If not improving switch to Ceftriaxone 80mg/kg IV q24h x 5-7 days

In adult

  • Ceftriaxone 2g IV q24h for 5 -7 days

If trauma:

  • Tension pneumothorax
    • High flow oxygen
    • Needle thoracocentesis
    • Chest-drain insertion
    • Analgesia
  • Open pneumothorax
    • High flow oxygen
    • Cover the wound with a 3-sided dressing
    • Chest-drain insertion
  • Flail chest
    • High flow oxygen
    • Analgesia
    • Consider intubation and ventilation