Asthma Escalation Pathway
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Addendum to Asthma Practice Pathway Severe Management Guidelines.
Patient should remain on continuous albuterol as ordered.
At any point during the escalation of care, please consider calling the CAT team
if additional bedside support is needed by any team member.
Patient
Classification:
Severe
Assessment:
Worsening respiratory distress/tiring on continuous albuterol?
No
Continue with
Severe
Management
Guidelines

No Improvement on Continuous or Adverse Effects
or
Hypoxemia without Worsening Respiratory Distress

Confer with nurse and respiratory therapist

Consider CAT call, making NPO, and converting
to IV methylprednisolone
Provider order for magnesium sulfate, to be sent to floor STAT, and normal saline bolus

Is patient ventilating well enough to
deliver the albuterol to the airways?

Assess aeration, degree of wheeze, tachycardia
No

Order and administer Subcutaneous Terbutaline

Call CAT team
Yes
Has magnesium sulfate
arrived on the floor?
Yes
No

Consider ordering or repeating subcutaneous terbutaline dose

Call CAT team if giving terbutaline
Nurse administers IV normal saline bolus and IV magnesium sulfate per provider order, may be administered simultaneously if BP stable
Continue with Severe Management Guidelines
Yes
Assessment:
Is patient improving
after magnesium
sulfate infusion?
No

Call CAT team if not previously called

Arrange for PICU transfer,
if appropriate