Acute asthma exacerbation

Question 1

Moderate asthma

Answer 1

Increasing symptoms
PEF >50-75%
No features of severe asthma

Question 2

Severe asthma

Answer 2

PEF 33-50%
RR more than equals to 25
HR more than equals to 110
Inability to complete sentence in one breath

Question 3

Life-threatening asthma 33,92 CHEST

Answer 3

Any of the following:
PEF <33%
SO2 <92% or PO2 <8
Cyanosis
Hypotension
Exhaustion, altered consciousness
Silent chest
Tachyarrhythmias

+ Normal PaCO2

Question 4

When to refer to ICU

Answer 4

Requiring ventilatory support
With acute severe or life-threatening asthma who is failing to respond to therapy, as evidenced by:
- Deteriorating peak flow reading
- Persisting or worsening hypoxia
- Hypercapnia
- Exhaustion, feeble respiration
- Respiratory arrest

Question 5

Management of acute asthma: IMMEDIATE

Answer 5

Sit-up
100% O2 via non-rebreathe mask (aim for 94-98%)
Nebulised salbutamol (5mg) and ipratropium (0.5mg)
Hydrocortisone 100mg IV or prednisolone 50mg PO

Question 6

Management of acute asthma: if LT

Answer 6

Inform the intensive care team
Magnesium sulphate 2g IV over 20 minutes
Nebulised salbutamol every 15min
If no improvement: aminophylline + ITU transfer for invasive ventilation

Question 7

Monitoring of acute asthma

Answer 7

ABG: consecutive
Peak flow every 15-30min
SpO2>92%