What In The Er For An Asthma Attack, What O2 Saturation Level Is O.k. For Discharge?

Question

Asked by Tess

What In The Er For An Asthma Attack, What O2 Saturation Level Is O.k. For Discharge?

Dear all,

I have a question. We recently went to the ER for an asthma attack. My 7.5 year old son, with CVA, had a flare up accompanied with fevers for 4 days. We maxed out his medications at home on his care plan and he was still in the red zone on his peak flow. After a 5 hour wait in the ER waiting room (his O2 sats were 99% upon arrival due to all the treatments) they began his nebulizers. Upon receiving 2 nebulizer treatments of atrovent and albuterol ( I believe), his O2 saturations came up from 91-92% to 94%. They were ready to send us home, but due to radiology forgetting to read the X-ray (thank goodness), we had to wait. He has a croup like presentation that at that point only responds to oral steroids. They finally consented to administering the oral steroids and about 1.5 hours post ingestions, his O2 saturations started to creep up to 97%/98%. These are my questions:

  1. At what saturation level is it o.k. to discharge a patient in this condition?
  1. Currently, he has about 4-5 bouts/year that are fairly serious. We've spent many a day in the pediatricians office receiving steroids, nebulizers, etc. but have never been admitted. Is it worth it for us to buy a home pulse oximeter? For us, we gage his oncoming attack (and recovery) by his peak flow and his level or hoarseness. He doesn't tend to wheeze.

  2. Also, when he becomes compromised, the steam shower seems to be quite helpful. Do you think that a warm saline nebulizer would be helpful in opening up his airway?

Thank you in advance for your advice. Please feel free to post these questions if you feel it may help others.

Thank you,

Tess


Answer

A normal oxygen saturation (sat) for any person is 98%. An acceptable sat for a 7 year old depends on the doctor and the presentation of the child. Recent studies show that a 90% sat is acceptable to go home. Still, our doctors usually like it to be 92% or better -- or even 94%. So you can see there is some flexability. This would be a great question to ask your doctor.

Do you need a pulse oximeter for home use? I think it would be rare for a doctor to recommend this for home use, but I'm sure there are exceptions. Usually with asthma

you are better off following your child's asthma action plan, and calling your doctor or going to the ER as soon as you realize his home med regime is not working -- just llike you did.

What works best for your child at home is something you definitely should discuss with your doctor. Perhaps you, your son, and your doctor may want to alter your asthma action plan.

Answered by John Bottrell