Guidelines for ED Observation of Asthma
May 1, 2002 2 minutes read
Guidelines for ED Observation of Asthma
TRANSFER CRITERIA
- Acceptable vital signs
- Intermediate response to therapy — improving but still wheezing
- Peak flow 40-70% of predicted (if reliable)
- Fair to good air exchange
- Alert and oriented
- Patients should receive at least two nebulized bronchodilator treatments and steroids prior to transfer to Observation Unit
EXCLUSION CRITERIA
- Unstable vital signs or clinical condition
- Poor response to therapy
- Elevated partial pressure of carbon dioxide (if done)
- Pulse oximetry <90 on room air after initial treatment
- Peak Flow <40% predicted value after initial treatment (if reliable)
- Persistent use of accessory muscles, respiratory rate >40 after initial treatment
- Pneumonia
- Lethargy
- Toxic theophylline level
- New electrocardiogram changes
POTENTIAL INTERVENTION
- Nebulized bronchodilator therapy
- Systemic steroids
- Chest X-ray
- Pulse oximetry, arterial blood gases
- Frequent reassessment
- Oxygen
- Telemetry Monitor System monitoring as needed
DISPOSITION
Home —
- Acceptable vital signs
- Resolution of bronchospasm or return to baseline status
- Peak flow >70% predicted
- Pulse oximetry >94% on room air
Hospital —
- Progressive deterioration in status
- Failure to resolve bronchospasm within 18 hours
- Co-existent pneumonia
- Carbon dioxide Retention
- Persistent peak flow <70% of predicted (if reliable)
- Unstable vital signs
- Pulse oximetry <90% on room air
Estimated Time in Unit: <18 hours
2/27/98
Source: William Beaumont Hospital, Royal Oak, MI.
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