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We are now using an asthma scoring system in the ED which should be placed on the charts of patients greater than 1 year of age who present with wheezing. We are targeting patients at least 1 year old in an effort to select out patients with bronchiolitis. The scoring system is based on 5 criteria including respiratory effort, accessory muscle use, auscultation, o2 sat on room air and sensorium. The patient will receive a score from residents, attendings, respiratory therapy and nursing staff and decisions about their therapy will be made based on their classification as mild, moderate or severe. After every intervention, please re-assess and re-score each patient and decide the best next step with the multidisciplinary team. Please be sure to document each patient's response to therapy on the clinical chart. Use the order sheets provided to document scores and to order appropriate medicines. The order sheets provide suggestions for therapy based on the classification of the patient's severity of exacerbation.

Frequent assessment and reassessment is the key to managing asthmatic patients.

In addition to standard therapy of beta-agonists, anticholinergics and steroids, there are many other drugs available to treat the critically ill asthmatic. These include magnesium sulfate, terbutaline, aminophylline, ketamine etc. Your attending and/or the critical care attending will be able to discuss these options with you when necessary for specific patients.

For information and articles on asthma, please reference the hard copy of this manual.

Articles include:

  1. The 1997 Asthma Management Guidelines and Therapeutic Issues Relating to the Treatment of Asthma
    By: John W. Georgitis, MD, FCCP
    Source: MD Consult
  2. Practice Parameters for the Diagnosis and Treatment of Asthma
    The Journal of Allergy and Clinical Immunology
    Vol. 96, No. 5, Part 2, November 1995
  3. 2. Algorithm for the diagnosis and management of asthma: a practice parameter update: Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology.
    Source: MD Consult

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