acute asthma

Question 1

history of acute asthma

Answer 1

prev admissions with exacerbation

atopy history - eczema and hayfever

admissions to ICU

allergies

Question 2

moderate acute asthma

Answer 2

increasing symptoms
PEFR >50-75% bets
no features of acute severe

Question 3

acute severe asthma

Answer 3

RR >25
HR > 110bpm
inability to complete sentences in one breath
PEFR 33-55% best

Question 4

life threatening asthma

Answer 4

o2 sats <92%
paO2 <8
paCO2 normal 
silent chest
cyanosis
poor respiratory effort
arrhythmia
hypotension
exhaustion
altered consciousness
PEFR< 33%

Question 5

NEAR FATAL signs of asthma

Answer 5

PaCO2 raised

require mechanical ventilation and raised inflation pressures

Question 6

target sats in acute asthma

Answer 6

94-98 if not at risk of hypercapnic resp failure

88-92 if at risk of hypercapnic resp failure (COPD)

Question 7

investigations is suspect asthma exac.

Answer 7

Peak flow

CXR (life threatening asthma)

Question 8

immediate management of acute asthma exac.

Answer 8

steroids
bronchodilators
additional therapy - magnesium sulphate

Question 9

immediate steroid management of acute asthma

Answer 9

hydrocortisone 100mg IV
or
prednisolone 40mg PO

Question 10

bronchodilator management of acute asthma

Answer 10

salbutamol 5mg nebulised w 6-7L/min O2. repeat if required

Ipratropium bromide 500micrograms w O2 4-6hrly

Question 11

magnesium sulphate in acute asthma

Answer 11

1.2-2g IV MgSO4 over 20min

Question 12

what to do if acute asthma patient requires 15L/min O2

Answer 12

give supplemental O2 via nasal cannula

Question 13

referrals in acute asthma

Answer 13

additional therapies

• disucss w senior member
• contact critical care outreach team
• referral to physiotherapy
• consider ICU

Question 14

when to consider ICU n acute asthma

Answer 14

failure to respond to treatment

patient requires ventilator support

patient requires blood pressure support

deterioration of blood gas following medical management