Emergency Medicine Cases Episode 79 – Management of Acute Pediatric Asthma Exacerbations
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Apr 12, 2016 Sanjay Mehta and Dennis Scolnik, both pediatric emergency physicians at the Hospital for Sick Children in Toronto, dive into the complexities of managing acute asthma in children. They share insights on risk stratification tools like PRAM scores and discuss when to use chest X-rays or blood gases. The conversation highlights the importance of early corticosteroid administration and the effectiveness of MDIs versus nebulizers. Controversies surrounding treatments such as ketamine and heliox are also explored, offering essential strategies for improving outcomes in emergency settings.
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Pediatric Asthma Risk Factors
- Key risk factors include previous severe exacerbations, ICU admissions, and steroid non-response.
- Lack of risk factors does not mean a child is safe from severe asthma attacks.
Use Clinical Scores for Severity
- Use PRAM or PASS scores to objectively assess asthma severity and guide treatment.
- These tools improve communication and standardize care, especially for moderate cases.
Limit Peak Flow Use to Older Kids
- Peak expiratory flow is unreliable in children under 7-8 years and not the primary diagnostic tool.
- Use it mainly for older children to exclude mimics or confirm diagnosis with over 15% improvement post-bronchodilator.