1 - Paeds - Resp - Asthma - Ix, DDx, Acute Exacerbation, Stages

Question 1

Usually Ix? why do Ix?

Answer 1

usually diagnosed from Hx and Ex and requires no Ix

done to confirm/explore severity/phenotype

Question 2

what Ix are done?

Answer 2

skin prick test for allergens
CXR (normal)
PEFR (variable)
response to treatment

Question 3

DDx??

Answer 3

GORD
CF
viral induced wheezing (common, ~1/2 of<3’s, resolves ~5y) bronchiolitis, croup

Question 4

Acute exacerbation of asthma - what to note on presentation?

Answer 4

duration of sx, treatment already given, course of previous attacks

Question 5

Features of an acute attack? 7 things

Answer 5

wheeze and tachypnoea (2-5y - >50/min, >5y - >30/min)

• tachycardia (>130/m in 2-5y, >120 in >5y)
• use of acc mm, and chest recession
• marked pulsus paradoxus
• SOB interferes with talking

Question 6

late signs of acute exacerbation of asthma

what to assess

Answer 6

cyanosis, fatigue, drowsiness, silent chest (emergency, resp arrest)

assess PEFR and sats

Question 7

moderate severity - O2?, PEFR? clin feat?

Answer 7

O2 >92%, PEFR >50% , no clin features of severe asthma

Question 8

moderate severity - mgmt?

Answer 8

SABA via spacer 2-4 puffs, increase by 2 puffs every 2 min up to 10 as required, consider oral pred, reassess 1hr

Question 9

severe attack - O2? PEFR? Clin feat?

Answer 9

O2 <92%, PEFR <50%

tachypnoea, tachycardia, acc mm use, too SOB to talk/feed

Question 10

severe attacks - mgmt?

Answer 10

O2 via face mask to increase sats, SABA neb or via spacer 10 puffs. Oral pred or IV hydrocortisone.
poor response/ neb ipratropium bromide, repeat SABA every 20-30mins PRN

Question 11

Life threatening attack - O2? PEFR? clin signs?

Answer 11

silent chest, poor resp effort, altered consciousness, cyanosis, O2<92% PEFR <33%

Question 12

life threatening - mgmt

Answer 12

O2 face mask, Neb SABA plus ipratropium bromide, IV hydrocortisone, contact senior, PICU, Paeds, repeat SABA every 20 mins