ABSTRACT
If the patient is improving: • continue oxygen; • continue steroids • repeat nebuliser four hourly. If the patient is not improving: • continue oxygen and steroids; • repeat nebulised salbutamol every 15-30 minutes; • add ipratropium to nebuliser, repeat six hourly. If the patient is still not still not improving after this treatment: • give aminophylline infusion; • salbutamol or terbutaline infusion; • monitor treatment with peak flow rate every 15-30 minutes, and oximetry
to keep a saturation above 90%; • repeat blood gases within two hours if initial PaO2 less than 8 kPa unless
subsequent saturation greater than 92%, or, if PaCO2 is normal or raised, to check whether patient is deteriorating;
• chart peak flow before and after giving nebuliser and inhaled beta agonists four times daily throughout hospital stay.
