Pediatrics

Bronchospasm

Diagnosis

May have:

  • ↓ EtCO2
  • Upslope stage III EtCO2
  • ↑ airway pressures
  • ↓ SpO2

Diagnosis

May have:

  • ↓ EtCO2
  • Upslope stage III EtCO2
  • ↑ airway pressures
  • ↓ SpO2

  1. Non-Intubated

    If severe, consider intravenous epinephrine 1-2 MICROgrams/kg IV (MAX 1 mg) or 10 MICROgrams/kg subcutaneous/intramuscular (MAX 0.5 mg)

    • 1-2 MICROgrams/kg, MAX 1 mg IV
    • OR
    • 10 MICROgrams/kg subcutaneous/intramuscular, MAX 0.5 mg

  2. Administer supplemental oxygen

  3. Auscultate the chest, differentiate from stridor/extrathoracic airway obstruction

  4. Consider inhaled albuterol (with spacer) 2.5-5 mg. If severe, 5-20 mg/hr inhaled

    • Non-Intubated: 2.5-5 mg; if severe, 5-20 mg/hr
    • Intubated: 4-10 puffs as needed

  5. Consider chest radiograph

  6. Consider IV steroids: methylprednisolone 1mg/kg IV (MAX 60 mg) or dexamethasone 0.15-0.25 mg/kg (MAX 16 mg)

    • Intubated: 2mg/kg IV, MAX 60 mg
    • Non-Intubated: 1mg/kg IV, MAX 60 mg
    • 0.15-0.25 mg/kg, MAX 16 mg

  7. If severe, consider ICU and/or advanced airway management

  8. Consider DDx

  9. Intubated

    If severe, consider epinephrine 1-2 MICROgrams/kg IV (MAX 1 mg)

    • 1-2 MICROgrams/kg, MAX 1 mg IV
    • OR
    • 10 MICROgrams/kg subcutaneous/intramuscular, MAX 0.5 mg

  10. Consider inhaled albuterol 4-10 puffs as needed

    • Non-Intubated: 2.5-5 mg; if severe, 5-20 mg/hr
    • Intubated: 4-10 puffs as needed

  11. Consider deepening anesthetic

  12. Auscultate the chest

    • Equal breath sounds?
    • Endobronchial ETT?
    • Wheezing?

  13. Check the ETT

    • Kinked?
    • Secretions/blood in the ETT? Need for suctioning?

  14. If needed, give ketamine 1-2 mg/kg IV

    • 1-2 mg/kg IV

  15. Consider IV steroids: methylprednisolone 2mg/kg IV (MAX 60 mg) or dexamethasone 0.15-0.25 mg/kg (MAX 16 mg)

    • Intubated: 2mg/kg IV, MAX 60 mg
    • Non-Intubated: 1mg/kg IV, MAX 60 mg
    • 0.15-0.25 mg/kg, MAX 16 mg

  16. Consider chest radiograph

  17. For refractory bronchospasm, consider magnesium 50-75 mg/kg (MAX 2 grams) bolused over 20 minutes, (CAUTION, may cause hypotension)

  18. Consider DDx

  19. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  20. Call for Transesophageal Echocardiography

  21. Start chest compressions

  22. Give epinephrine 10 MICROgrams/kg IV/IO

    • 1-2 MICROgrams/kg, MAX 1 mg IV
    • OR
    • 10 MICROgrams/kg subcutaneous/intramuscular, MAX 0.5 mg

  23. If cardiac arrest, go to CARDIAC ARREST

  24. Consider ECMO

Patient weight

Between 0.5 kg and 120 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.