Acute asthma Flashcards
What is acute asthma?
An acute exaccerbation of the symptoms of asthma
What can acute asthma be triggered by?
Respiratory tract infection
Exercise
Cold weather
What are the main features of acute asthma?
Worsening dyspnoea
Wheeze
Cough
Not responding to salbutamol
How is acute asthma graded?
Moderate
Severe
Life-threatening
What is moderate acute asthma?
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
What is severe acute asthma?
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
What is life-threatening acute asthma?
PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
What does a a normal pCO2 in an acute asthma attack indicate?
Exhaustion- therefore classified as life-threatening
What investigaitons can be done for someone with a suspected acute asthma atack?
ABG
Routine blood tests
Chest x-ray
What might you find with an ABG in someone having a life threatening acute asthma attack?
Type 2 respiratory failure- low PaO2 and high PaCO2
Why might you do a FBC and chest x-ray in someone presenting with an acute asthma attack?
To look for precipitating causes
How many life-threatening features does a patient need to have for it to be treated as life-threatening?
Only one
When would you carry out an ABG for a patient presenting with an acute asthma attack?
If the oxgyen sats < 92%
When might you do a chest x-ray for someone presenting with acute asthma attack?
Life-threatening asthma
Suspected pneumothorax
Failure to respond to treatment
When would you admit a patient with an acute asthma attack to hospital?
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
What would you start a patient on of they were hypoxaemic?
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%.
What is the first step in the medcial management of acute asthma attack?
Bronchodilation with short-acting beta₂-agonists (SABA)
What are examples of SABA’s that can be used in the management of an acute asthma attack?
Salbutamol
Terbutaline
How is the SABA administered in a patient not having a life threatening acute asthma attack?
A standard pressurised metered-dose inhaler (pMDI)
or
An oxygen-driven nebulizer
How is the SABA administered in a patient having a life threatening acute asthma attack?
Nebulised SABA
What other medical management is given to patients having an acute asthma attack?
Corticosteroids
What corticosteroid should be given to a patient having an acute asthm attack?
40-50mg of prednisolone orally (PO) daily
How long should the steroids be continued?
At least five days or until the patient recovers from the attack
What should the patient continue to take while recovering from acute asthm attack?
Continue their normal medication routine including inhaled corticosteroids
When might you administer ipratropium bromide?
Patients with severe or life-threatening asthma
or
Patients who have not responded to beta₂-agonist and corticosteroid treatment
What type of medication is ipratropium bromide?
short-acting muscarinic antagonist (SAMA)
What IV medication might you give for life-threatening asthma?
IV magnesium sulphate
IV aminophylline
When might you give IV aminophylline?
If severe and inadequate bronchodilatory response from nebulisers
What might patients have an acute asthma attack require if they fail to respond to treatment?
Transfer to ITU/HDU
–intubation and ventilation
–extracorporeal membrane oxygenation (ECMO)
