Emergency Management of Status Asthmaticus in Children

Life-threatening status asthmaticus in children is sufficiently common so that all emergency departments receiving children must have a management strategy prepared for this disease. The strategy encompassing both the prehospital and the emergency department phases relies on frequent inhalation of nebulized bronchodilators (typically albuterol and ipratropium), intravenous steroids, and prompt endotracheal intubation in children with obtundation, hypoxia, or inaudible breath sounds. Death should be preventable in this disease if the child receives aggressive medical attention before respiratory arrest has developed. However, the best therapy involves prevention by ensuring that children with a history of severe asthma receive adequate anti-inflammatory therapy usually with inhaled steroids before life-threatening status asthmaticus develops.