EMRA Simulation Guide

Pulmonary - Asthma Exacerbation

CASE: 28-year-old female with a history of asthma presents with acute shortness of breath

Learning Objectives

1. Make patient NPO
2. Treat anaphylaxis with appropriate doses of epinephrine, H1-blocker, H2-blocker, steroids
3. Administer a 20 cc/kg bolus of IV fluids
4. Supplemental oxygen
5. Obtain pertinent history to identify anaphylaxis to peanuts
6. Admit patient to pediatric ICU

Critical Actions

• Obtain IV access with two large bore peripheral IVs
• Place patient on monitors with continuous oxygen saturation monitoring
• Place patient on continuous end-tidal capnography
• Ask for a full set of vital signs including HR, BP, oxygen saturation, and temperature
• Early supplemental oxygen
• Obtain history critical for identifying possible anaphylaxis
• Early administration of epinephrine
• Early administration of steroids, H1, H2 medications
• Perform a full physical exam including airway and skin
• Request airway equipment on standby
• Request a 20 cc/kg bolus of IV fluids
• Reassessment of vitals
• Appropriate disposition (Admission)
• Closed-loop communication
• Synthesis of case to admitting physician
• Disclose appropriate information to the patient/family

Download the case here.