Respiratory Conditions and management in the CHOA ED

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Respiratory Conditions and management in the
CHOA ED

• P. Patrick Mularoni, MD

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Asthma

• At both the HS and Egleston there is a
  Respiratory Therapist in the ED
• There are protocols in place which allow for the
  immediate administration of both Albuterol and
  Atrovent
• These medicines are both preferentially given in
  the nebulized form

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Asthma

• Albuterol
• -Intermittent treatments are given as
• 2.5 mg for children lt 15 kg
• 5 mg for children gt 15 kg
• -Continuous treatments can be given as
• either 7.5, 10, or 15 mg over one hour

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Asthma

• Atrovent
• 0.5 mg of this Anti-cholinergic medicine is
  given to patients to decrease cough, decrease
  secretions, and provide direct bronchodilatory
  activity

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Steroids

• Solumedrol
• -Give 2 mg per Kg IV as an initial dose up to 60
  mg per dose
• Prednisone (15 mg/5 ml)
• - Also give 2 mg/kg as an initial dos
• - most attendings give 2 mg/kg per day for 5
  days

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Magnesium

• Given for its smooth muscle dilation properties
  it is given IV at 40 mg/kg
• This is the third line treatment chosen most
  often at CHOA
• Watch patients blood pressure
• Patients who resolve pst Magnesium can still go
  home

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Terbutaline

• Given as a sub-Q Beta agonist
• .01 mg/kg up to a maximum dose of 0.5 mg
• Sub Q Epi can also be given as .01 mg/kg per dose
• Usually given as the 11000 form so it ends up
  being .01 ml/kg
• Max dose is 0.5 ml

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Ketamine

• For patients who are hyperventilating to a point
  that respirations are uneffective or for those
  where a CPAP trial is warranted
• Ketamine can be given at a dose of 0.5-1mg/kg

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Croup

• Racemic Epinephrine is given at a dose of .05
  ml/kg/dose
• This can be given q 15 minutes
• Decadron should also be given at a dose of 0.6
  mg/kg
• If Racemic is given for stridor patients must
  be observed for at least 2 hours

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Bronchiolitis

• RSV season begins in the ATL in August
• No we dont have any real treatments for RSV
  here either
• Please try to get patients to the Trauma room
  before intubating them

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Foreign Bodies

• FBs are handled by the surgery team
• Before calling them please get a nose to rectum X
  ray
• If a patient had an X ray at an outside
  institution, repeat the X ray then call your
  friendly surgeon

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Respiratory Failure

• We have CPAP machines available at both campuses
• There is also High flow O2 that comes from the
  NICU for small patients needing extra PEEP

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Intubation

• Respiratory will be present at all intubations
• Fellows are not permitted to intubate a patient
  outside the ED without direct attending
  supervision

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Intubation

• We have moved to an Etomidate and Rocuronium for
  RSI
• Unless contraindicated use Etomidate 0.3 mg/kg
  and then Vecuronium 0.1mg/kg
• Atropine can be used but many of us are not using
  it presently
• Dont forget Lidocaine if your worried about
  increased ICP

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