Action
- Give high-dose short-acting beta agonist (SABA) + ipratropium by nebulizer or metered-dose inhaler (MDI) + spacer every 20 min for first hour
- Consider continuous nebulized albuterol therapy if no clinical improvement with intermittent therapy
- Administer first dose of IV corticosteroids immediately
- Consider magnesium IV (Class II) and adjunctive therapies such as epinephrine IM and ketamine
Decision
Reassess. Improved?
Yes
- Admit to hospital ward
No
Evidence of impending or actual respiratory arrest:
- Prepare for intubation without delay
- Continue short-acting beta agonist (SABA) while preparing for intubation
- Recommended rapid sequence intubation medications: ketamine 2 mg/kg + rocuronium or succinylcholine
- If not requiring intubation at this time, consider starting noninvasive positive-pressure ventilation (NIPPV)
- If not improved, consider admission to hospital intensive care unit
- (Class II)
