Acute asthma exacerbation Flashcards
What are the features of an acute attack?
Worsening dyspnoea
Wheeze
Cough
THAT IS NOT RESPONDING TO SALBUTAMOL
What is a moderate acute attack?
PEFR 50-75%
Speech normal
RR <25/min
Pulse <110 bpm
What is a severe acute attack?
PEFR 33-55%
Can’t complete sentences
RR >25/min
Pulse >110bpm
What is a life-threatening acute attack?
PEFR <33% O2 sats <92% Silent chest Cyanosis Feeble resp effort Bradycardia Dysarrythmia/ hypoTN Exhaustion Confusion/coma
What is near fatal asthma?
Raised pCO2 and/or requiring mechanical ventilation w raised inflation pressures
What does a normal PCO2 in acute asthma indicate?
Exhaustion and should therefore be classified as life-threatening
What IX are needed?
PEFR
ABG - it O2 <92%
In which cases is an CXR done?
Life-threatening asthma
Suspected pneumothorax
Failure to respond to RX
What are the admission criteria?
Life-threatening attack
Features of severe attack persisting despite initial RX
How is it MX?
(1) Sit-up
(2) 100% O2 non-rebreath mask (aim for 94-98%)
(3) Neb Salbutamol (5mg) and ipratropium (0.5mg)
(4) 40-50mg PRED PO
How do you MX life-threatening attack?
- Inform ITU
- MgSO4 IVI over 20min
- Neb Salbutamol every 15min (monitor ECG)
What do you do if there is not improvement in 15-30 min of MX?
- Nebulised Salbutamol every 15 min (monitor ECG)
- Continue Ipratropium 0.5mg 4-6hrly
- MgSO4 2g IVI over 20 min
- Salbutamol IVI
- Consider aminophylline
- ITU transfer for invasive ventilation
What to do after improvement?
- Monitor SpO2
- Continue pred PO daily for 5d at least or until fully recovered
- Neb salbutamol every 4h
What are the criteria for discharge?
1 - Stable on discharge meds (no neb/O2 for 12-24h)
2 - Inhaler technique checked and recorded
3 - PEF >75%
What is the discharge plan?
TAME
PO OD pred for 5d
GP appt within 1w
Resp clinical appt within 1m
