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 astma  



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Author12 Posts
  #1

A 3-year-old with a history of asthma is brought to the Emergency Department in acute respiratory distress. His mother relates that she stopped his twice daily sodium cromoglycate 1 week ago. Physical examination reveals a distressed child with a harsh cough. On auscultation of the chest, there are areas of reduced air entry and diffuse expiratory wheezes. Which one of the following is the most appropriate initial management?


1) aerosolized ipratropium bromide by nebulization

2) aerosolized sodium cromoglycate by nebulization

3) aerosolized budesonide

4) subcutaneous epinephrine, 1:1000 dilution

5) aerosolized salbutamol by nebulization






  #2

5) aerosolized salbutamol by nebulization



  #3

Why not Ipratromium bromide?


  #4

5-aerosolized salbutamol.

beta agonists are the 1st line therapy for acute episode/exacerbation. mast cell stabilizers are more for maintainence.



  #5

5


  #6

agree with 5


  #7

5 because salbutamol = albuterol is used everyday in the ER !


  #8

no 5. agree



  #9

5, ipratropium added if not responding well


  #10

Wyvern,

The real answer is : Hydration, beta-2 agonist, and parenteral corticosteroid.

If the patietn does not response to beta-2 agonist, I may give ipratropium but parenteral corticosteroid is the next best alternative , not ipratropium.

Did I ever give ipratropium in the ER ? all the time for 15 years-20 years but is not the best answer in the exam.

There is a difference between the best answer in the exam and real life.



  #11

Remember "inhaled" beta-2 agonist first !


  #12

I agree AAAAA but steroids arent in the options so i didnt mention it but you are 100% right mannod





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