Asma Flashcards

1
Q

Near fatal asthma

Moderate asth|Acute severe asth|Life-threatening asth|Near fatal asth

A

Near fatal asthma:
* Raised PaCO2
* Requiring mechanical ventilation with raised inflation pressures.

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2
Q

Aminophylline

A

Aminophylline
Loading dose 5mg/kg; add dose to 100ml glucose 5% or sodium chloride 0.9%

Maintenance infusion
0.5mg/kg/hour; Add 500mg (20ml) to 500ml glucose 5% or sodium chloride 0.9%

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3
Q

Salbutamol (infusion solution 5mg/5ml)

A
  • Salbutamol (infusion solution 5mg/5ml)
  • Initially 5microgram/minute adjusted according to response and heart rate. Usual range 3-20microgram/minute.

Preparation
* Dilute 5ml of solution with 500ml glucose 5% or sodium chloride 0.9% (concentration = 10 microgram/ml)

Infusion Rate (ml/hour)
18
30
48
60
90
120
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4
Q

ASMA

Moderate asthma

Moderate asth|Acute severe asth|Life-threatening asth|Near fatal asth

A
  • PEF >50–75% best or predicted
  • SpO2 ≥92%
  • Respiration <25/min
  • Pulse <110 beats/min
  • Can complete sentence in one breath
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5
Q

Acute severe asthma

Moderate asth|Acute severe asth|Life-threatening asth|Near fatal asth

A
  • PEF 33–50% best or predicted
  • Features of severe asthma:
    1. PEF<50% best or predicted
    2. Respiration ≥25/min
    3. Pulse ≥110 beats/min
    4. Cannot complete sentence in one breath
    5. SpO2 ≥92%
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6
Q

Life-threatening asthma

Moderate asth|Acute severe asth|Life-threatening asth|Near fatal asth

A
  • PEF <33% best or predicted
  • Exhaustion, altered consciousness
  • SpO2<92%, Cyanosis
  • Poor respiratory effort, Silent chest
  • Arrhythmia, hypotension
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7
Q

PEF & Asthma

A

Moderate asthma: PEF >50–75% best or predicted
Acute severe asthma: PEF 33–50% best or predicted
Life-threatening asthma: PEF <33% best or predicted

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8
Q

Moderate asthma - Treatment

A

Give β2 bronchodilator via spacer (give one puff at a time; according to response, give another puff every 60 seconds up to maximum of 10 puffs)

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9
Q

Blood gas markers of a life-threatening asthma attack

A

*PaCO2 ‘Normal’ (4.6–6 kPa, 35–45 mmHg)
* Severe hypoxia: PaO2 < 60 mmHg irrespective of treatment with oxygen
* A low pH (or high H+)

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10
Q

IMMEDIATE TREATMENT of acute asthma 1/2

IMMEDIATE TREATMENT|SUBSEQUENT MANAGEMENT| MONITORING

A
  1. Oxygen to maintain SpO2 94–98%
  2. β2 bronchodilator (salbutamol 5 mg) via an oxygen-driven nebuliser
  3. Ipratropium bromide 0.5 mg via an oxygen-driven nebuliser
  4. Prednisolone tablets 40–50 mg or IV hydrocortisone 100 mg
  5. No sedatives of any kind
  6. Chest X-ray if pneumothorax or consolidation are suspected or patient requires mechanical ventilation
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11
Q

IMMEDIATE TREATMENT of acute asthma 2/2

IMMEDIATE TREATMENT|SUBSEQUENT MANAGEMENT| MONITORING

A

FIRST 1/2:
SpO2 94–98%; salbutamol 5 mg; Ipratropium bromide 0.5 mg via an oxygen-driven nebuliser; IV hydrocortisone 100 mg

IF LIFE-THREATENING FEATURES ARE PRESENT:
1. IV magnesium sulphate 1.2–2 g infusion over 20 minutes
2. salbutamol 5 mg up to every 15-30 minutes
3. OR 10 mg per hour via continuous nebulisation (requires special nebuliser)

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12
Q

SUBSEQUENT MANAGEMENT of acute asthma 1/2
— NOT IMPROVING—

IMMEDIATE TREATMENT|SUBSEQUENT MANAGEMENT| MONITORING

A
  • Continue oxygen and steroids
  • Nebulised salbutamol 5 mg every 15–30
    minutes;
  • Ipratropium 0.5 mg 4–6 hourly until patient is improving
  • Use continuous nebulisation of salbutamol at 5–10 mg/hour if an appropriate nebuliser is available.
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13
Q

SUBSEQUENT MANAGEMENT of acute asthma 2/2
— NOT IMPROVING—

IMMEDIATE TREATMENT|SUBSEQUENT MANAGEMENT| MONITORING

A

IF PATIENT IS STILL NOT IMPROVING:
* ICU team
* IV magnesium sulphate 1.2–2 g over 20 minutes (unless already given)
* IV β2 bronchodilator or IV aminophylline or mechanical ventilation

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14
Q

SUBSEQUENT MANAGEMENT of acute asthma
— IMPROVING—

IMMEDIATE TREATMENT|SUBSEQUENT MANAGEMENT| MONITORING

A

IF PATIENT IS IMPROVING continue:
* Oxygen to maintain SpO2 94–98%
* Prednisolone 40–50mg daily or IV hydrocortisone 100 mg 6 hourly
* Nebulised β2 bronchodilator with ipratropium 4–6 hourly

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