How will you manage a child with acute asthma in a FRU set up

Managing a child with acute asthma in a First Referral Unit (FRU) set up requires prompt assessment, appropriate treatment, and close monitoring to stabilize the child’s condition and prevent respiratory compromise.

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Here’s a step-by-step guide on how to manage a child with acute asthma in an FRU:

1. Initial Assessment and Triage:

1. Assessment of Severity: Quickly assess the severity of the child’s asthma exacerbation using clinical signs and symptoms, such as respiratory rate, accessory muscle use, oxygen saturation, and degree of dyspnea.
2. Triage: Prioritize the child’s care based on the severity of symptoms, with severe exacerbations requiring immediate intervention and potentially life-threatening exacerbations requiring emergency treatment.

2. Oxygen Therapy:

1. Oxygen Administration: Administer supplemental oxygen to children with acute asthma exacerbations who are hypoxic (oxygen saturation < 92%) or in respiratory distress to improve oxygenation and relieve respiratory distress.
2. Oxygen Delivery Devices: Use appropriate oxygen delivery devices based on the child’s age and clinical condition, such as nasal cannula, oxygen mask, or high-flow nasal cannula, to deliver oxygen at the required flow rate.

3. Bronchodilator Therapy:

1. Short-Acting Beta-Agonists (SABA): Administer a short-acting beta-agonist (e.g., salbutamol) via nebulization or metered-dose inhaler (MDI) with a spacer to relieve bronchospasm and improve airflow.
2. Repeated Doses: Repeat bronchodilator treatments every 20 minutes for the first hour or until there is significant improvement in symptoms, followed by hourly or as-needed administration based on clinical response.

4. Systemic Corticosteroids:

1. Oral or Intravenous Corticosteroids: Administer systemic corticosteroids (e.g., prednisolone) to children with moderate to severe asthma exacerbations to reduce airway inflammation and prevent relapse.
2. Dosage and Duration: Prescribe an appropriate dosage of corticosteroids based on the child’s weight and severity of exacerbation, typically for a duration of 3 to 5 days.

5. Other Medications:

1. Anticholinergics: Consider adding an anticholinergic medication (e.g., ipratropium bromide) to the bronchodilator regimen for children with severe exacerbations or inadequate response to SABA alone.
2. Methylxanthines: In cases of severe exacerbations not responding to initial bronchodilator therapy, consider administering intravenous methylxanthines (e.g., aminophylline) under close monitoring.

6. Monitoring and Supportive Care:

1. Continuous Monitoring: Continuously monitor the child’s respiratory status, oxygen saturation, heart rate, and clinical response to treatment.
2. Fluid Management: Maintain adequate hydration with oral or intravenous fluids as needed, especially in children with prolonged exacerbations or dehydration.

7. Disposition and Follow-Up:

1. Disposition: After stabilization, determine the child’s disposition based on the response to treatment and severity of exacerbation. Consider admission to a higher level of care if the child’s condition is not improving or if there are concerns about safety at home.
2. Follow-Up: Provide clear instructions for follow-up care, including medication regimen, monitoring of symptoms, and when to seek medical attention if symptoms worsen or do not improve.

8. Education and Prevention:

1. Asthma Education: Provide education to the child and caregivers on asthma management, including trigger avoidance, proper inhaler technique, medication adherence, and the importance of having an asthma action plan.
2. Preventive Measures: Discuss strategies for preventing future exacerbations, such as avoiding triggers (e.g., allergens, respiratory infections), using controller medications regularly, and seeking prompt medical attention for worsening symptoms.

By following these steps, healthcare providers in FRU settings can effectively manage acute asthma exacerbations in children, optimize treatment outcomes, and reduce the risk of complications or relapse. Additionally, providing education and support to children and caregivers can empower them to better manage asthma at home and prevent future exacerbations.