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Respiratory > Acute asthma > Flashcards

Acute asthma Flashcards

1
Q

What is acute asthma?

A

An acute exaccerbation of the symptoms of asthma

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2
Q

What can acute asthma be triggered by?

A

Respiratory tract infection
Exercise
Cold weather

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3
Q

What are the main features of acute asthma?

A

Worsening dyspnoea
Wheeze
Cough
Not responding to salbutamol

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4
Q

How is acute asthma graded?

A

Moderate
Severe
Life-threatening

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5
Q

What is moderate acute asthma?

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

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6
Q

What is severe acute asthma?

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

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7
Q

What is life-threatening acute asthma?

A

PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

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8
Q

What does a a normal pCO2 in an acute asthma attack indicate?

A

Exhaustion- therefore classified as life-threatening

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9
Q

What investigaitons can be done for someone with a suspected acute asthma atack?

A

ABG
Routine blood tests
Chest x-ray

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10
Q

What might you find with an ABG in someone having a life threatening acute asthma attack?

A

Type 2 respiratory failure- low PaO2 and high PaCO2

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11
Q

Why might you do a FBC and chest x-ray in someone presenting with an acute asthma attack?

A

To look for precipitating causes

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12
Q

How many life-threatening features does a patient need to have for it to be treated as life-threatening?

A

Only one

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13
Q

When would you carry out an ABG for a patient presenting with an acute asthma attack?

A

If the oxgyen sats < 92%

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14
Q

When might you do a chest x-ray for someone presenting with acute asthma attack?

A

Life-threatening asthma
Suspected pneumothorax
Failure to respond to treatment

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15
Q

When would you admit a patient with an acute asthma attack to hospital?

A

Life-threatening attack
Severe attack not responding to treatment
A previous near-fatal attack
Pregnancy
Attack occurring despite using oral corticosteroid and presentation at night

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16
Q

What would you start a patient on of they were hypoxaemic?

A

Oxygen- 15L of supplemental via a non-rebreathe mask
Titrate down to a flow rate where they are able to maintain a SpO₂ 94-98%.

17
Q

What is the first step in the medcial management of acute asthma attack?

A

Bronchodilation with short-acting beta₂-agonists (SABA)

18
Q

What are examples of SABA’s that can be used in the management of an acute asthma attack?

A

Salbutamol
Terbutaline

19
Q

How is the SABA administered in a patient not having a life threatening acute asthma attack?

A

A standard pressurised metered-dose inhaler (pMDI)
or
An oxygen-driven nebulizer

20
Q

How is the SABA administered in a patient having a life threatening acute asthma attack?

A

Nebulised SABA

21
Q

What other medical management is given to patients having an acute asthma attack?

A

Corticosteroids

22
Q

What corticosteroid should be given to a patient having an acute asthm attack?

A

40-50mg of prednisolone orally (PO) daily

23
Q

How long should the steroids be continued?

A

At least five days or until the patient recovers from the attack

24
Q

What should the patient continue to take while recovering from acute asthm attack?

A

Continue their normal medication routine including inhaled corticosteroids

25
Q

When might you administer ipratropium bromide?

A

Patients with severe or life-threatening asthma
or
Patients who have not responded to beta₂-agonist and corticosteroid treatment

26
Q

What type of medication is ipratropium bromide?

A

short-acting muscarinic antagonist (SAMA)

27
Q

What IV medication might you give for life-threatening asthma?

A

IV magnesium sulphate
IV aminophylline

28
Q

When might you give IV aminophylline?

A

If severe and inadequate bronchodilatory response from nebulisers

29
Q

What might patients have an acute asthma attack require if they fail to respond to treatment?

A

Transfer to ITU/HDU
–intubation and ventilation
–extracorporeal membrane oxygenation (ECMO)

Respiratory (47 decks)

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