21. Emergencies- Asthma Attack

Question 1

What are some differentials for an asthma attack?

Answer 1

Exacerbation of COPD
Pulmonary oedema
URTI obstruction
Pulmonary embolis
Anapylaxis

Question 2

What should be gathered from the history?

Answer 2

Current medications
Previous acute episodes
Best peak expiratory flow rate
Have you ever been admitted to ICU

Question 3

What investigations should be done for someone who has asthma?

Answer 3

PEF (may be too unwell)
ABG
FBC, U&E’s

Question 4

What is the difference between a severe and a life threatening attack?

Answer 4

Severe- RR>25, pulse>110, PEF 33-50%, unable to talk in sentences

Life threatening- PEF<33%, silent chest, confusion, arrythmia, hypostenion, sats below 92%

Question 5

What immediate treatment should be delivered in a severe of life threatening asthma attack

Answer 5

Supplemtal oxygen to maintain sats
Salbutamol 5mg or tetrabutaline nebulised with O2
Add in ipratropium 0.5g to nebulisers
Hydrocortisone (IV) or prednisolone oraly

Question 6

What should happen after re-assessment every 15 minutes?

Answer 6

If PEF<75% do salbutamol nebulsiers every 15-30 mins or 10mg/h continously. Add ipratropium if not already given

Monitor ECG for arrythmias

Consider single dose of magnesium sulphate IV over 20 if there is a poor initial response

Question 7

What should you do if the patient is not improving?

Answer 7

Refer to ICU for consideration of ventialtory support and intensification of medical therapy

Question 8

When should IV salbutamol be considered?

Answer 8

Deteriorating PEF
Persistent/worsening hypoxia
Hypercapnoa
ABG showing low pH or high H ions
Exhaustian, poor respiration
Drowsiness, confusion, altered concious
Respiratory arrest

Question 9

What do you do if the patient is improving within 30 mins?

Answer 9

Salbutamol nebulisers every 4-6 hours

Prednisolone 40-50mg for 5-7 days

Monitor peak flow and O2 aim for 94-98%

If PEF over 75% after 1hr consider discharge with outpatient follow up

Question 10

If a patient does not recover after 1 hour, what criteria should be met to allow discharge?

Answer 10

Been stable on medication for 24 hours
Had inhaler technique checked
Peak flow greater than 75%
Steroid andbronchodialtor therapy
Gp appointment within 2 days
Respiratory clinic appointment within 4 weeks