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Clinical Assessment Tool for the Child with Acute Exacerbation of asthma 2-16 Years Management within a Community Setting Suspected Acute exacerbation of Asthma:
Consider other diagnosis if any of the following are present: •Fever •Dysphagia •Productive Cough •Breathlessness with light headiness and peripheral tingling (hyperventilation) •Asymmetry on auscultation •Excessive vomiting •Inspiratory Stridor Suspected Acute Exacerbation of Asthma.
Moderate Exacerbation
Severe Exacerbation
Life Threatening
•Give 2-10 puffs of ß2 agonist via a
prongs to achieve Sp02 94-98%
achieve Sp02 94-98%
•Give ß2 agonist 10 puffs via spacer
•Give Nebulised ß2 agonist and
Increase ß2 agonist dose by 2 puffs
•Repeat ß2 agonist up to every
Assess response
repeat ß2 agonist via oxygen
Good Response:
•Advise patient to continue using ß2
•Recent hospital admission or previous severe attack •Concern over social circumstances or ability to cope at home Clinical Assessment Tool for the Child with Acute Exacerbation of asthma 2-16 Years Management within a Community Setting Table 1: Traffic Light system for identifying signs and symptoms of clinical dehdration and shock Green – Moderate
Amber – Severe
Red – Life Threatening
*Consider influence of fever &/or Salbutamol CRT: capillary refill time RR: respiration rate
Table 2: Normal Paediatric Values:
Table 4: Guidelines for nebuliser
Respiratory Rate at Rest:
Systolic Blood Pressure
• Significantly low sats despite inhaler and spacer use • Oxygen Saturations persistently below 96% • Unable to use volumatic/spacer device Heart Rate
Salbutomol
2-5 years– 2.5mg, 5-12 years– 2.5-5mg, 12-16 years– 5mg Ipratropium
Table 3: Predicted Peak Flow: For use with EU / EN13826
scale PEF metres only
Table 5: Prednisolone Guideline BNF2010-2011
Give prednisolone by mouth:
child under 12 years 1–2 mg/kg (max. 40 mg) daily for up to 3 days or longer if necessary, if the child has been taking an oral corticosteroid for more than a few days give prednisolone 2mg/kg (max. 60mg). Child12-18 years BTS guidelines 2011: (if weight not available)
Use a dose of 20mg for children 2-5 years and 30-40mg This guidance is written in the following context
This assessment tool was arrived at after careful consideration of the evidence available including but not exclusively use BTS Guidelines and NHS
evidence. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. The guidance does not, however, override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Source: http://www.lllg.org/l2g/custom/files_uploaded/uploaded_resources/13298/Asthmasheet.pdf