Paeds Vivas · respiratory-sleep-and-airway
Acute severe and life-threatening asthma — branching viva
Branching viva on acute severe and life-threatening asthma: grading severity, delivering and escalating the stepwise pathway, recognising the danger signs of impending respiratory failure, managing the child failing intravenous therapy, and planning safe discharge and prevention.
On this page
Study tools
Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Emergency department: an 8-year-old with known asthma arrives hunched forward, too breathless to speak in sentences, with marked recession, a widespread expiratory wheeze and an oxygen saturation of 88% on air after using her reliever repeatedly at home. The examiner asks: how do you grade the severity and what is your immediate management — then branches to the child who is not responding, to the child who deteriorates to a silent chest and rising carbon dioxide, and finally to disposition and preventing the next episode.
Opening question
This 8-year-old can speak only in words, is saturating 88% on air with marked work of breathing and a widespread wheeze. How do you grade her severity, and what are your immediate management priorities? [1] [4]
References4ShowHide
- [1]Leung JS. Paediatrics: how to manage acute asthma exacerbations. Drugs Context, 2021.PMID 34113386
- [2]Griffiths B, Kew KM. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Cochrane Database Syst Rev, 2016.PMID 27126744
- [3]Craig SS, Dalziel SR, Powell CV, et al. Interventions for escalation of therapy for acute exacerbations of asthma in children: an overview of Cochrane Reviews. Cochrane Database Syst Rev, 2020.PMID 32767571
- [4]Edmonds ML, Milan SJ, Camargo CA Jr, et al. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev, 2012.PMID 23235589