![]() A CXR should be considered in patients with rhonchi, uneven breath sounds, or areas of focal consolidation on lung exam, patients in respiratory failure, and patients not responding to treatment. ![]() Chest X-Ray (CXR): A CXR should not be routinely ordered in children with an acute asthma exacerbation.An alternative to measuring blood gases would be using end-tidal carbon dioxide monitoring. If a trial of non-invasive positive pressure ventilation is conducted, a blood gas can also help assess response. However, repeating a VBG in patients with hypercarbia can assess the degree of improvement after treatment. Intubation should be based on clinical presentation and response to treatment alone and not based on blood gas values. A venous blood gas (VBG) can be used as an alternative to an ABG in patients who are not hypoxic. However, as the symptoms progress and air-trapping gets worse, an ABG may show respiratory acidosis with hypercarbia. Initial findings can be hypoxia and hypocarbia due to hyperventilation. Arterial Blood Gas (ABG): an ABG can be useful to help gauge the severity of an asthma exacerbation in moderate to severe exacerbations.However, an elevated WBC count is non-specific and may be elevated from the acute asthma exacerbation itself. Some argue that if a fever is present with purulent productive sputum, and an infectious process in suspected, a CBC may be ordered. Laboratory tests: In known asthmatics, there is no indication for any laboratory testing.However, prompt recognition and treatment of asthma should be initiated before any tests are ordered. A few ancillary tests with some utility in specific circumstances are listed below. There is no indication for diagnostic laboratory tests or imaging in children with a known of asthma with clinical presentation consistent with asthma. What is the oxygen saturation? Place child on pulse oximetry.Is the child maintaining their airway? This can be assessed by their ability to speak or cry.The primary survey involves the following: When a child presents to the emergency department, they are often brought in for wheezing, persistent cough, decrease in level of activity, and/or an increased work of breathing. The diagnosis of asthma can often be made with a thorough history and physical exam alone. The differential diagnosis of children presenting with the above signs and symptoms include pneumonia, croup, bronchiolitis, pediatric congestive heart failure, pneumothorax, foreign body, and severe allergic reactions. Hypoxia is the inability to achieve adequate oxygenation due to severe bronchospasm, while hypercarbia is often a late-sign and is due to the inability to exhale carbon dioxide. These include: cough, shortness of breath, wheezing, retractions, drowsiness, and respiratory failure with hypoxia and/or hypercarbia. Children who present with an acute asthma exacerbation or “attack” present with a variety of signs and symptoms. Childhood asthma is a leading cause of emergency department visits and hospitalizations in the United States. Initiate appropriate treatment for a pediatric acute asthma exacerbationĪsthma is a chronic disease of the lungs that involves bronchial inflammation and hyperresponsiveness with intermittent reversible bronchospasm.Demonstrate the utility of diagnostic testing in an acute exacerbation.Understand the initial management of a child presenting with acute asthma.Recognize the clinical presentation of a child with acute asthma.Upon finishing this module, the student will be able to: SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education GrantĬareer Development and Mentorship CommitteeĬommunications and Social Media CommitteeĬDEM Medical Education Fellow Travel Scholarship Presidential Address: Where Do We Go From Here?ĮMF/SAEMF Medical Student Research Training Grant Virtual Rotation and Educational ResourcesĬommittee Update: NBME EM Advanced Clinical Examination Task Force Visit us on Twitter LinkedIn Facebook YouTubeĮffective Consultation in Emergency Medicine Video
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