acute asthma attack

Question 1

23 y.o. asthmatic brought into A+E dept with an acute exacerbation

became increasingly SOB over the last 3 h

you make a dx of an acute asthma attack

(a) give 2 clinical factors you would wish to establish when taking a hx from this pt in order to assess the severity of her attack

Answer 1

1. what her usual PEFR is (for comparison purposes)
2. whether she is able to finish a sentence in one breath
3. what her conscious level is (via GCS)

Question 2

(b) give 4 clinical factors you should establish in the examination of the pt in order to assess the severity of her attack

Answer 2

1. mental status (confused / exhausted?)
2. HR (>110 = attack; bradycardia = life-threatening)
3. RR (>25 = attack; very low = life-threatening)
4. presence of breath sounds (silent chest = life-threatening)
5. presence / lack of cyanosis
6. use of accessory muscles
7. resp effort
8. pulsus paradoxus ^{(>=10mmHg drop in systolic BP during inspiration. manifests clinically ‘paradox’ of hearing heart beats on inspiratory auscultation that cannot be palpated at the radial pulse)}

Question 3

(c) what immediate ix might usefully be performed in A+E and what abnormality in each would cause you concern?

Answer 3

1. current PEFR: expected (>75% mild, 50-75% moderate, 33-50% severe, <33% life-threatening)
2. ABG: hypoxia, normo- or hypercapnia and uncompensated acidosis
3. CXR: infection
4. SpO2: hypoxia

Question 4

(d) what 3 categories of immediate rx would you consider for this pt?

Answer 4

1. oxygen therapy: high-flow via trauma mask
2. bronchodilators: either nebulised or IV based on severity e.g. 5mg salbutamol O2-drive neb
3. steroids: e.g. 40mg oral prednisolone or if unable to swallow, 200mg IV hydrocortisone