Acute asthma

Question 1

What can cause airway compromise in patients?

Answer 1

Secretions

Question 2

What signs would be associated with potential airway compromise?

Answer 2

See-saw breathing
Use of accessory muscles
Diminished breath sounds
Added sounds
Cyanosis

Question 3

What might be heard when auscultating a patients chest with acute asthma?

Answer 3

Reduced air entry

Wheeze - becomes less apparent with increasing obstruction

Question 4

How much oxygen should be used?

Answer 4

15L through a non-rebreather

Question 5

What drug is used as a first line agent in asthma?

Answer 5

Beta-2-agonists

Question 6

How often should nebulised salbutamol be given in an acute, severe, asthma attack? And at what dose?

Answer 6

When required or every 20-30mins

5mg

Question 7

What dose of steroids should be given PO in acute asthma?

Answer 7

40-50mg prednisolone

Question 8

If the oral route is not available to give steroids, what route and agent should be used?

Answer 8

IV hydrocortisone

100mg every 6 hours

Question 9

Other than salbutamol, what other nebulised drug should be started initially?

Answer 9

Ipratropium Bromide (0.5mg 4-6hourly)

Question 10

What circulatory interventions should be performed?

Answer 10

IV access

Bloods

Question 11

What bloods should be taken?

Answer 11

FBC
U&E
LFT
Clotting
CRP

Question 12

What other drugs can be used in the treatment of acute asthma (not salbutamol/steroids/ipratropium)

Answer 12

IV Magnesium sulphate

IV aminophylline

Question 13

What is the typical ABG picture in acute asthma?

Answer 13

pH - alkalosis often present due to hyperventilation
PaCO2 - often low due to hyperventilation
PaO2 - may be low

Question 14

What criteria would suggest a moderate asthma exacerbation?

Answer 14

Increasing asthma symptoms. PEFR >50-70% of best or predicted.
No features of severe asthma.

Question 15

What criteria would suggest a severe asthma exacerbation?

Answer 15

PEFR 33-50% of best or predicted
Respiratory rate greater or equal to 25 breaths/min
Pulse greater or equal to 110 beats/min
Inability to complete sentences in one breath

Question 16

What criteria would suggest a life-threatening asthma exacerbation?

Answer 16

PEFR <33% of best or predicted
Oxygen saturation <92%
Silent chest
Cyanosis
Poor respiratory effort
Bradycardia
Hypotension
Dysrhythmia
Confusion
Exhaustion
Coma