What is EMS Prehospital Evaluation and Treatment of Asthma in Children?
Asthma is the most common long-term disease found among children and is often the cause for immediate medical attention in a pediatric emergency. This piece will look into how emergency medical services, prior to arriving at the hospital, evaluate and handle sudden severe asthma attacks in children.
What Causes EMS Prehospital Evaluation and Treatment of Asthma in Children?
Asthma is a long-term condition that causes the airways in your lungs to tighten, get blocked with mucus, and swell up. This can lead to ongoing symptoms, but during what doctors call ‘flares’ or ‘exacerbations’, these symptoms get worse. During these times, people with asthma have trouble breathing and find it hard to exhale, especially when trying to breath out forcefully.
Risk Factors and Frequency for EMS Prehospital Evaluation and Treatment of Asthma in Children
In the United States, out of the around 1 to 2 million children who have emergency medical services (EMS) encounters every year, about 10% to 15% are related to asthma and breathing problems. Albuterol is the medication most often given to children by EMS. Therefore, EMS providers should be knowledgeable in taking care of a child who is having an asthma attack.
Signs and Symptoms of EMS Prehospital Evaluation and Treatment of Asthma in Children
Emergency medical services (EMS) aim to quickly assess patients and gather their relevant medical history due to the time-sensitive nature of their work. The ultimate goal of EMS is to transport patients to an emergency department (ED). A method used for quick and effective patient assessment is the pediatric assessment triangle (PAT). This method evaluates the patient’s appearance, breathing effort, and circulation. The PAT can help determine the level of care needed and identify whether a patient is stable, in respiratory distress, or facing respiratory failure.
EMS providers should observe the patient’s signs of respiratory stress such as their positioning, retractions, nasal flaring, and audible wheezing. They should also listen for abnormal lung sounds. A lack of these sounds could actually be a warning sign of poor air movement in a patient, indicating possible respiratory failure.
Relevant information in the patient’s history includes any known asthma diagnoses, what triggered the current asthma episode, any medication they’re taking for asthma, and past visits to the ED or hospital for asthma — especially those resulting in stays in the intensive care unit or requiring the use of a breathing tube (intubation).
In children under the age of 2, it’s important to remember that bronchiolitis can look a lot like asthma. And for toddlers, wheezing could be a sign that they’ve swallowed a foreign object.
Testing for EMS Prehospital Evaluation and Treatment of Asthma in Children
Checking the patient’s health before they reach the hospital usually includes quick observations of the person’s condition, a spoken account of their symptoms, and physical checks, as well as monitoring vital signs such as heartbeat, breathing rate, and temperature. Emergency medical service (EMS) providers can also measure the amount of oxygen a patient’s blood is carrying with a tool called a pulse oximeter.
If the oxygen level is less than 90% to 94%, it suggests a shortage of oxygen in the body, a condition known as hypoxia. Sometimes, EMS systems might also use a method called capnography. This measures the amount of carbon dioxide that’s exhaled at the end of each breath, which gives them an idea of how well the person is breathing.
Treatment Options for EMS Prehospital Evaluation and Treatment of Asthma in Children
When a medical emergency service provider suspects an asthma attack in a patient, the treatment delivered depends on the provider’s certification level. Basic emergency medical technicians (EMTs) can provide supplemental oxygen and assist the patient in using their inhaler. However, it’s essential to note that inhaled corticosteroids, like fluticasone, aren’t effective in treating asthma attacks. The medications an intermediate EMT can administer will depend on local regulations.
Paramedic EMTs can provide more advanced medication following local guidelines. The first line of treatment for a patient with breathing problems or wheezing due to asthma involves inhaled beta-2-agonists like albuterol. They help relax the airways’ muscles and increase the movement of mucus, improving the patient’s breathing. Common side effects include rapid heartbeat and shakes. In more rare cases, children might experience abnormal heart rhythms. For such patients, combining albuterol with ipratropium bromide can decrease the need for hospital admission.
Children suffering from asthma attacks should receive systemic corticosteroids within an hour of arrival in the emergency department. They help speed patient recovery, decrease length of stay in the hospital, and lower the chance of relapse. The effectiveness of systemic corticosteroids given by EMS isn’t as strong as in the hospital setting. However, some studies found decreased hospital admission rates following corticosteroid use in EMS.
Options for systemic corticosteroids include oral and intravenous (IV) forms. While IV methylprednisolone is commonly used, the effectiveness of oral and IV corticosteroids is the same. Prednisolone is available in oral solution, tablet, and oral dissolving tablet. Dexamethasone can be given orally or through IV but has been linked to severe allergic reactions and intense discomfort. Therefore, there is controversy over its use in treating pediatric asthma.
Additional therapies are available for seriously ill children. Subcutaneous epinephrine relaxes the muscles around the airways and can be given by injection or autoinjector. IV magnesium is also documented to reduce the need for hospital admissions. Other potential treatments include Bronchodilator Terbutaline, positive pressure, or mechanical ventilation for those with severe breathing difficulty and Ketamine for patients with agitation. However, evidence for the use of Ketamine in the ED and EMS setting is limited.
What else can EMS Prehospital Evaluation and Treatment of Asthma in Children be?
When doctors are diagnosing lung-related issues, they take into account several conditions that may have similar symptoms. These can include:
- Aspergillosis (a fungal infection in the lungs)
- Bronchiolitis (inflammation of the small airways)
- Bronchiectasis (damaged and widened air passages)
- Chronic obstructive pulmonary disease or COPD (lung disease making it hard to breathe)
- Chronic sinusitis (long-term swelling and inflammation of the sinuses)
- Cystic fibrosis (an inherited disorder causing severe damage to the lungs)
- Foreign body aspiration (inhaling an object into the lungs)
- Gastroesophageal reflux disease or GERD (chronic disease where stomach acid flows back into the esophagus)
- Heart failure (condition where the heart doesn’t pump blood as well as it should)
- Pulmonary embolism (a blood clot in the lungs)
These conditions can present similar symptoms, therefore, the doctor has to perform adequate tests to pinpoint the exact cause of the problem.
