Acute Asthma

Question 1

How does acute asthma present?

Answer 1

• Progressive dyspnoea
• Use of accessory muscles
• Chest tightness/pain
• Anxiety

Question 2

What signs might you find?

Answer 2

• Symmetrical expiratory wheeze
• Reduced air entry
• Tachypnoea
• Hypoxia
• Silent chest

Question 3

What are the parameters for moderate acute asthma?

Answer 3

• PEFR 50-75%

Question 4

What are the parameters for severe acute asthma?

Answer 4

• PEFR 33-50%
• RR 25+
• HR 110+
• Unable to complete a sentence in a breath

Question 5

What are the parameters for life threatening acute asthma?

Answer 5

• PEFR <33%
• SATs <92%
• Silent chest/no respiratory effort
• Hypotension
• Arrythmias

Question 6

What are the parameters for near fatal acute asthma?

Answer 6

Raised pCO2

Question 7

How is acute asthma treated?

Answer 7

O SHIT ME

• Oxygen (target 94-98%)
• Salbutamol 5mg neb (back to back)- use ECG
• Hydrocortisone 100mg IV/Prednisolone 40mg PO
• Ipratropium bromide 500mcg neb (4-6 hourly)
• Theophylline
• MgSO4 2g IV over 20 minutes
• Escalate

Question 8

What should be monitored when on salbutamol and why?

Answer 8

Potassium

- Salbutamol causes hypokalaemia

Question 9

What is a ‘rescue pack’ in asthma?

Answer 9

Prescribed steroids for a person to initiate if they have a future exacerbation.
NICE recommend referral to asthma specialist after 2 attacks in 12 months.

Question 10

Which treatment steps are done in ITU?

Answer 10

• Theophylline

- Magnesium sulphate

Question 11

What will an ABG initially show, and why?

Answer 11

• Respiratory alkalosis

- Drop in CO2 (Tachypnoea)

Question 12

What acid-base status is present in later stages and why?

Answer 12

• Respiratory acidosis
• Patient cannot keep up effort and RR drops
• CO2 rises