Acute Asthma Flashcards
Describe the features of life threatening asthma
Silent chest Cyanosis Poor respiratory effort Exhaustion Arrythmia Hypotension Altered consciousness Peak flow < 33% SaO2 < 92%
Describe features of severe asthma
Too breathless to talk SaO2<92% for < 12 yo Peak flow 33-50% RR: > 40/min for 2-5yo >30/min for 5-12yo >25/min for 12-19yo HR: >140/min for 2-5yo >125/min for 5-12yo >110/min for 12-18yo
Describe features of moderate asthma
Able to talk SaO2>92% Peak flow > 50% RR: 40 or less for 2-5 30 or less for 5-12 25 or less for 12-18 HR: 140 or less for 2-5 125 or less for 5-12 110 or less for 12-18
What are causes of acute breathlessness in child?
Asthma Pneumonia or LRTI Foreign body Anaphylaxis Penumothorax or pleural effusion MEtabolis acidosis - diabetic ketoacidosis, lactic acidosis Severe anaemia Heart failure Panic attacks
When should children be admitted?
After high dose inhaled bronchodilator they:
Have not responded adequately clinically - tachypnoea, breathless still
are becoming exhausted
Still have a marked reduction in their predicted peak flow rate or FEV1 (<50%)
Have reduced O2 sats (<92% in air)
How is acute breathlessness managed?
High dose inhaled bronchodilators
Steroids
Oxygen
Describe management of moderate asthma
Reassure
SABA via spacer with face mask for under 3
2-4 puffs increasing by 2 puffs every 2 mins to 10 puffs if required
Oral prenisolone 1-2mg/kg, max 40mg
Monitor response for 15-30 mins
Describe management of severe asthma
SABA via spacer, 10 puffs or nebuliser salbutamol (2.5mg in <8, 5mg in >8)
Assess response and repeat as required
Oral prednisolone or IV hydrocortisone
Consider:
Inhaled ipratropium
IV B2 agonist salbutamol or aminophylline or magnesium
Describe management of life-threatening asthma
Nebulised salbutamol (2.5mg in <8, 5mg in >8)
Assess response and repeat as required
Oral prednisolone or IV hydrocortisone
Nebulised ipratropium
Consider:
IV salbutamol or aminophylline or magniseium
Discuss with PICU
What should you do if they are responding to treatment?
Continue bronchodilators 1-4h PRN
Discharge when stable on 4h treatment
Continue oral prednisolone for 3-7 days
What should you do if they are not responding to treatment.
TRansfer to HDU/PICU Ensure senior review Consider IV therapies Consider CXR for pneumothorax or infection and blood gases Consider ventilation
Why might you use IV therapy?
Inhaled therapies may be delivered in suboptimal doses to areas of lung that are poorly ventilated.
Children may fail to respond to inhaled therapy
First choice = magnesium sulphate
SE of IV aminophylline?
Seizures, severe vomiting, arrythmias - ECG monitoring
SE of IV salbutamol?
Hypokalaemia - muscle cramp/weakness, irregular heartbeat ECG changes Tremor Tachycardia Vomiting Difficulty urinating
What information should you give patient on discharge?
When drugs should be used - preventer/reliever
How to use drug - inhaler technique
What each drug does
How often and how much can be used - frequency and dosage
What to do if asthma worsens - action plan
