asthma Flashcards
what is an asthma attack?
acute or subacute worsening in symptoms and lung function from the patients usual status or in some cases the initial presentation of asthma
what is the presentation of an acute asthma attack below 5 years?
presentation varies depending on childs age
5 years and under: recurrent wheezing triggered by viral upper respiratory tract infections is common
infants and preschool children in more subtle ways
coughing, runny nose, noisy breathing, wheezing
what is the presentation of an acute asthma attack above 5 years?
similar to adults
progressive increase in symptoms of shortness of breath, cough, wheeze, and/or chest tightness
progressive decrease in lung function (peak expiratory flow compared with previous or predicted values), difficulty talking
increased heart rate
increased respiratory rate with use of accessory muscles of respiration
reduced oxygen saturation
what is stridor?
high pitched sound on asucultation due to turbulent air flow usually heard during inspiration and localised over the throat
often occurs in children with croup
when can you hear crackles?
pneumonia and tuberculosis
when is best to hear wheeze?
auscultation of chest
what are they key treatments in the initial management of acute asthma/ wheeze in primary care?
oxygen
inhaled short acting beta2 agonists
oral corticosteroids
which children need urgent transfer to hospital in an ambulance?
children with low oxygen saturation (under 92%) or those with other features of a severe or life threatening attack
children with a poor response to iniital treatment with ongoing signs and symptoms after treatment with beta2 agonists
what are the signs of an inhaled foreign body?
symptoms come on very suddenly
reduced breath sounds on one side and is afebrile
unilaterally reduced breath sounds , lack of previous history
what indicates a severe attack of asthma?
oxygen below 92%
agiated and distressed
moderate to marked increased work of breathing (accessory muscle use and/or chest wall recession)
marked limitation of ability to talk
sits hunched forwards
HR above 140/min in children aged 1-5
above 125/min in children over 5
resp rate above 40/min in children aged 1-5
above 30/min in children over 5
what is the best management for mild to moderate asthma attack with normal oxygen saturatio?
10 puffs of salbutamol via a spacer and consider oral corticosteroids if symptoms don’t settle with salbutamol alone or if effects do not last for 3-4 hours indiciating more severe attack
what is the management of children with poor response to initial treatment, oxygen sat below 92%, features of severe or life threatening attacks?
high risk, transferred to hospital by ambulance
whilst waiting for transfer:
give oxygen via tight fitting mask or nasal cannula with flow rates adjusted as necessary
give oral prednisolone
give salbumatol via oxygen driven nebuliser
if poor response to initial dose of salbutamol, ipratropium bromide added to each subsequent nebuliser
oxygen always continued in hypoxic children
when is magnesium sulphate used for treatment?
life threatening attack in hospital
when treating an acute attack in a GP, when is it safe to send them home?
SpO2 greater than 94% and PEF greater than 75% of best or predicted
beta2 agonists needed no more frequently than 10 puffs every 4 hours
