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Respiratory Conditions and management in the CHOA ED

Respiratory Conditions and management in the CHOA ED. P. Patrick Mularoni, MD. 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

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Respiratory Conditions and management in the CHOA ED

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  1. Respiratory Conditions and management in the CHOA ED P. Patrick Mularoni, MD

  2. 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

  3. Asthma • Albuterol -Intermittent treatments are given as: 2.5 mg for children < 15 kg 5 mg for children > 15 kg -Continuous treatments can be given as either 7.5, 10, or 15 mg over one hour

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

  5. 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

  6. 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

  7. 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 1:1000 form so it ends up being .01 ml/kg • Max dose is 0.5 ml

  8. 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

  9. 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

  10. Bronchiolitis • RSV season begins in the ATL in August • No we don’t have any “real treatments” for RSV here either • Please try to get patients to the Trauma room before intubating them

  11. Foreign Bodies • FB’s 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

  12. 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

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

  14. 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 • Don’t forget Lidocaine if your worried about increased ICP

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