Acute Asthma Flashcards
What symptoms might be reported by a patient experiencing an asthma attack?
Shortness of breath, wheeze, cough, chest tightness
What signs might you find on examination of a patient with acute asthma attack?
Respiratory distress:
- Tachypnoea
- Tachycardia
- Accessory muscle use
- Wheeze, poor air movement or diminished breath sounds
What differentials would you consider alongside asthma attack?
Acute infective exacerbation of COPD
Pulmonary oedema
Upper respiratory tract obstruction
P.E.
Anaphylaxis
What investigations would you want to do for someone with signs of acute exacerbation of asthma?
**Peak flow meter (if able to)
**ABG
FBC
UE
CXR to rule out causes or other differential diagnoses
What categorises an asthma attack as being ‘Severe’?
Unable to complete sentences in one breath.
Respiratory rate ≥ 25/min.
Pulse rate ≥110 beats/min.
PEF 33-50% of predicted or best.
What categorises an asthma attack as being ‘Life-threatening’?
PEF <33% of predicted or best.
Silent chest, cyanosis, feeble respiratory effort.
Arrhythmia or hypotension.
Exhaustion, confusion, or coma.
Arterial blood gases:
- Normal/high PaCO2 >4.6kPa.
- PaO2 <8kPa, or SaO2 <92%.
How is acute asthma managed?
Early administration of bronchodilators and corticosteroids:
- SABA’s (salbutamol 5 mg neb)
- Anticholinergics (ipratropium 0.5 g/6h neb)
- Corticosteroids (Prednisolone 40-50 mg PO; OR hydrocortisone 100 mg IV)
Additional therapy/further actions:
- O2
- Mg
- ICU referral for mechanical ventilation and intense treatment
How do you know whether or not a patient with acute asthma is heading towards requiring ICU intervention?
PEF continues to deteriorate despite treatment
Persistent/worsening hypoxia
Hypercapnia
ABG shows acidosis
Exhaustion, feeble respiration, quiet chest
Drowsiness, confusion, altered consciousness
Respiratory arrest
