Acute Severe Asthma Flashcards

1
Q

In a patient you suspect to have acute severe asthma, what are the key points in the history?

A

Precipitant: infection, travel or exercise?
Usual and recent Rx?
Previous attacks and severity: ICU admissions?
Best PEFR

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2
Q

In pt with acute severe asthma, what are the key investigations?

A

PEFR
ABG - PaO2 normal or slightly low
PaCO2 low = normal
If PaCO2 elevated, send to ITU for ventilation
Bloods: FBC, U&E, CRP, blood cultures
CXR to rule out pneumothorax/pulmonary oedema

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3
Q

What are the features of severe asthma?

A

PEFR <50%
RR >25
HR >110
Can’t complete sentences in one breath

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4
Q

What are the features of life threatening asthma

A
PEFR <33%
SpO2 <92%, PaCO2 >4.6kPa, PaO2 <8kPa 
Cyanosis
Hypotension
Exhaustion, confusion
Silent chest, poor respiratory effort
Tachy/brady/arrhythmias
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5
Q

What are the differentials of acute severe asthma

A

Acute exacerbation of COPD
Pneumothorax
Pulmonary oedema

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6
Q

What are the admission criteria?

A

Life threatening attack

Features of severe attack persisting despite initial Rx

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7
Q

When could you discharge if admission was not necessary?

A

May discharge if PEFR >75% 1h after initial Rx

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8
Q

Discharge when

A

Been stable on discharge meds for 24h

PEFR is >75% with diurnal variability <25%

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9
Q

Discharge plan

A
TAME pt 
Checked inhaler technique
PO steroids for 5d
GP appointment within 1 week
Respiratory outpt clinic appointment within 1 month
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10
Q

Management of acute severe asthma - O2, nebs and steroids

A

Sit up
100% O2 via non-rebreathe mask, aim for sats 94-98%
Nebulised salbutamol 5mg (every 15min or 10mg continuously/ hour) & ipratropium 0.5mg 4-6hrly
Hydrocortisone 100mg IV or prednisolone 40-50mg PO or both
Write “no sedation” on drug chart

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11
Q

Mx of life threatening asthma

A

Inform ITU
MgSO4 2g IVI over 20mins
Nebulised salbutamol every 15mins

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12
Q

If improving:

A

Monitor SpO2 - aim 92-94%, PEFR
Continue pred 40-50mg for 5 days OD
Nebulised salbutamol every 4 hours

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13
Q

IV Rx if no improvement within 15-30min

A
Neb salbutamol every 15 min (monitor ECG)
Continue ipratropium 0.5mg 4-6hrly
MgSO4 2 IVI over 20min
Salbutamol IVI 3-20ug/min
Consider aminophylline - load 5mg/kg IVI over 20 min unless already on theophylline
Continue 0.5mg/kg/hr
Monitor levels 
ITU transfer for invasive ventilation
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14
Q

Monitoring of acute severe asthma

A

PEFR every 15-30 min
- pre and post beta-agonist
SpO2: keep >92%
ABG if initial PaCO2 normal or higher

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