pediatric sob - asthma

 keep child and parents calm

keep child in his comfortable position 

don't upset child or forcing him/her to put o2 mask or examine throat 

give high flow o2 15ml/min via mask or NRM

dexamethasone 150microgram/kg oral , if child refuse to wallow orally , nebulized budesonide 2mg 

nebulized adrenaline 400micro-gram/kg to maximum 5mg (0.4ml/kg to maximum 5ml of 1:1000 ), repeat if no response after 30min

if severe symptoms , admit the child , if become well observe for 3hr before discharge 

contact consultant for the case, if no improvement or worsening of symptoms , ET and transfer to PICU

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