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HPI 5yo child with acute asthmatic attackNote vital signs: BP, Pulse, Resp. Rate, Temp. Step I : Emergent management: A, B, C, D- O2 , broncodilaters MDI or nebulizer, depending on severity consider systemic corticosteroids.Step II : Physical Examination General appearance, HEET/Neck, Chest/Lung, Heart/CVStep III : Diagnostic Investigations: 1. O2 sat.2. PEF3. CBC4. Chem 75. CXR6. ABG- should be considered in severe distress of when FEV1 <30% of predicted values after initial treatment.Treatment: 1. O22. Beta 2 agonist with MDI or Nebulizer every 20 mins 3. methyprednisolone IV q6h for first 24-48 hours then inhaled steroidsStep IV: Decision about changing patients location Discharge home if symptoms resolve quickly or FEV1 is greater than 70% of predicted or personal best.Recommendation for hospitalization1. response to treatment is poor2. recent hospitalization for asthma3. failure of aggressive outpatient management4. previous life- threatening attack.5. If PEF or FEV1 is less than 50%6. arterial carbon dioxide tension is greater than 427. If patient is confused of drowsy8. If no easy access to ERIf patient is discharge need to return to office within 5-7 days for follow up.Step V: Educate patient and family:Instruct patient/family to avoid factors that aggravate patients disease.Instruct on proper use of MDI STEP VI: Final Diagnosis.Acute Asthma Attack

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