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Asthma Exacerbation Severity Evaluation
Aka: Asthma Exacerbation Severity Evaluation
- See Also
- Emergency Management of Asthma Exacerbation
- Asthma Exacerbation
- Asthma Education
- Asthma Management
- Asthma Exacerbation Home Management
- Asthma Inpatient Management
- Status Asthmaticus
- Asthma-Related Death Risk Factors
- Criteria: Mild Exacerbation
- Symptoms
- Breathlessness while walking
- Able to lie supine
- Speaks in sentences
- Possible Agitation
- Signs
- Increased Respiratory Rate
- No accessory muscle use or retractions
- End-Expiratory Wheezes
- Heart Rate <100
- Pulsus Paradoxus absent (<10 mmHg difference)
- Diagnostics
- Peak Expiratory Flow (PEF) >70% of predicted or of personal best
- O2 Sat >95% on room air
- Arterial Blood Gas (Not typically indicated)
- PaO2 normal on room air
- PCO2 <42mmHg
- Criteria: Moderate Exacerbation
- Symptoms
- Breathlessness while walking and at rest (infant with softer, shorter cry)
- Prefers sitting to lying supine
- Speaks in phrases
- Agitation
- Signs
- Increased Respiratory Rate
- Accessory muscle use and retractions
- Loud Wheezes throughout expiration
- Heart Rate 100-120
- Pulsus Paradoxus possibly present (10-25 mmHg difference)
- Diagnostics
- Peak Expiratory Flow (PEF) 40-69% of predicted or of personal best
- O2 Sat >90-95% on room air
- Arterial Blood Gas (Not typically indicated)
- PaO2 >60 mmHg on room air
- PCO2 <42mmHg
- Criteria: Severe Exacerbation
- Symptoms
- Breathlessness at rest (infant does not feed)
- Sits upright
- Speaks in words
- Agitation
- Signs
- Increased Respiratory Rate >30/minute
- Accessory muscle use and retractions
- Loud Wheezes throughout inspiration and expiration
- Heart Rate >120
- Pulsus Paradoxus present (>25 mmHg difference in adults and 20-40 mmHg difference in children)
- Cyanosis may be present
- Diagnostics
- Peak Expiratory Flow (PEF) <40 of predicted or of personal best
- O2 Sat >90% on room air
- Arterial Blood Gas (Respiratory Failure)
- PaO2 <60 mmHg on room air
- PCO2 >42mmHg
- Criteria: Life-Threatening Exacerbation with imminent respiratory arrest
- Symptoms
- Includes severe symptoms as above
- Drowsy
- Confused
- Signs
- Includes severe signs as above
- Paradoxical thoracic and abdominal muscle excursion
- Wheezing absent
- Bradycardia
- Pulsus Paradoxus absent (secondary to respiratory muscle Fatigue)
- Diagnostics
- Includes severe exacerbation diagnostic results as above
- Peak Expiratory Flow (PEF) <25% of predicted or of personal best (or unable)
- References
- Fuchs and Yamamoto (2011) APLS, Jones and Bartlett, Burlington, p. 66-7
- (2007) National Asthma Education and Prevention Program Guidelines, U.S. HHS NIH, 07-4051