(4) Skin and mucous membranes. Check the child's skin for signs of
dehydration. Check his lips and nail beds for evidence of cyanosis.
(a) Listen to the child's respiratory sounds. You are checking for rales
(abnormal respiratory sounds, sounding high-pitched or like rubbing hair together near
your ear), and wheezes (high- pitched, whistling sounds). The patient's chest sounds
are noisy in a mild or moderate asthma attack. As the asthma attack progresses, there
are increased breath sounds with loud, expiratory wheezes and sometimes rales. As
the asthma attack becomes even more severe, the patient's breath sounds are harder
and harder to hear.
(b) Be sure to listen to the child's entire chest. A child with localized
wheezing may have a foreign body obstructing his airway. A child with asthma,
however, will have wheezing which can be heard all over his chest.
A silent chest means danger!
c. Treatment. Treatment is similar to that for acute asthma and includes the
Administer humidified oxygen by mask.
Begin an IV lifeline with normal saline.
(3) Give epinephrine 1:1000 SQ in the dose of 0.01 mg per kilogram.
Repeat in 20 to 30 minutes.
Remember, the use of epinephrine may be hazardous to the child if he
has already taken high doses of bronchodilator medication by inhalation!
To avoid such a medication mistake, be sure you have taken a good
history of the child.
(4) You may administer aerosolized bronchodilator through the nebulizer.
Epinephrine or albuterol may be given. Monitor the child's heart rate and discontinue
the nebulizer if his heart rate exceeds 160 beats per minute or if dysrhythmias develop.
(5) Encourage the child to cough up any secretions as he takes the