acute asthma summarised Flashcards
where do children under 2 who have acute asthma need to be treated
hospital
what is the immediate management of children under 2 with moderate to severe acute asthma
immediate treatment with oxygen via tight fitting face mask or nasal prongs to achieve normal SpO2 of 94-98%
what is the immediate treatment of children under 2 with moderate to severe acute asthma - b2 agonist or oxygen?
immediate treatment with oxygen via tight fitting face mask or nasal prongs to achieve normal SpO2 of 94-98%
immediate treatment of children under 2 with moderate to severe acute asthma is oxygen via tight fitting face mask or nasal prongs to achieve SpO2 94-98%. what next?
trial inhaled SABA
if response poor, combine nebulised SAMA ipratropium to each nebulised SABA dose
in severe asthma attacks in pt under 2, you need to consider the early use of this drug
oral prenisolone daily for up to 3 days
what is first line treatment for acute asthma in adults and what should it be given via
high dose inhaled SABA given ASAP
mild to moderate: can be via spacer and pMDI
acute severe or life threatening: recommended via oxygen driven nebuliser
1st line acute asthma in adults is high dose inhaled SABA given ASAP. if severe or life threatening symptoms, recommended via oxygen driven nebuliser. if response to initial dose of nebulised SABA is poor, what can you consider
consider continuous nebulised SABA with an appropriate nebuliser
Who are IV b2 agonists reserved for in adults
patients in whom inhaled therapy cant be used reliably
2 alternatives in patients who are unable to take oral prednisolone
IM methylprednisolone
IV HC
When can nebulised ipratropium (SAMA) be combined with nebulised B2 agonist in adults?
(2)
in pt with severe or life threatening acute asthma
or in pt with poor inital response to b2 agonist therapy to provide greater bronchodilation
there is some evidence that magesium sulphate has bronchodilator effects. when can a single IV dose of this be considered in adults?
pt with severe acute asthma (PF <50% B/P) who have not had good initial response to inhaled bronchodilator use
When can IV aminophylline be used in adults??
Note - in acute asthma it is not likely to produce any additional bronchodilation compared to standard therapy with inhaled bronchodilators and CCs
in some patients with near-fatal or life-threatening acute asthma with a poor response to initial therapy, intravenous aminophylline may provide some benefit
on senior medical staff advice only
when should supplementary high flow oxygen be given to children 2 and over
Supplementary high flow oxygen (via a tight-fitting face mask or nasal cannula) should be given to ALL children with life-threatening acute asthma or SpO2 < 94% to achieve normal saturations of 94–98%
1st line treatment for acute asthma in children aged 2 and over
inhaled SABA given ASAP
mild to moderate acute asthma: via pMDI and spacer
dose individualised according to severity and adjusted based on response
A child’s symptoms of asthma have returned within 3-4 hours. What to do?
urgent medical attention
a further or larger dose (max 10 puffs salbutamol via spacer) should be given whilst awaiting medical condition
1st line acute asthma in children 2 and above is inhaled b2 agonist. What if they have had poor inital response to this?
nebulised ipratropium can be combined with nebulised b2 agonist if poor initial response to b2 agonist therapy to provide greater bronchodilation
consider adding the following to each nebulised salbutamol and ipratropium bromide in the first hour in children with short duration of severe acute asthma symptoms presenting with oxygen satruation less than 92%
magnesium sulphate
what to do if child has continuing severe acute asthma despite frequent nebulised beta2 agonists and ipratropium bromide plus oral corticosteroids, and those with life-threatening features
urgent review by a specialist with a view to transfer to a high dependency unit or paediatric intensive care unit (PICU) to receive second-line intravenous therapies
what can be considered as 1st line IV treatment in children who respond POORLY to first line treatments (inhaled bronchodilators)
intravenous magnesium sulfate
early addition of the following ….. can be an option in a severe asthma attack where child has not responded to initial inhaled therapy
single bolus dose of intravenous salbutamol
when can continuous IV infusion of salbutamol (specialist supervision, continuous ECG and electrolyte monitoring) be considered in children
unreliable inhalation or severe refractory asthma
when can IV aminophylline be considered in children
severe or life-threatening acute asthma unresponsive to maximal doses of bronchodilators and corticosteroids
