Asthma

Question 1

Signs of life threatening asthma attack?

Answer 1

LIFE-THREATENING:
• Altered consciousness.
• Exhaustion
• Cyanosis
• Silent chest
• Poor respiratory effort
• PEF <33% best/predicted.
• SpO2 <92%
• Arrhythmia
• Hypotension

Question 2

Signs of acute severe asthma attack?

Answer 2

• PEF 33-50% best/predicted.
• SpO2 >92% or equal to
• Inability to complete sentence in one breath
• HR >110
• Respiratory rate >25

Question 3

General asthma symptoms?

Answer 3

• Wheezing
• Chest tightness
• SOB/DIB
• Diurnal variation
• Cough
• Tripod

Question 4

How would you assess for a suspected asthma attack?

Answer 4

1. Danger- Scene safe?
2. GOCAT
3. Gain consent.
4. Airway- foreign body? Patent? Positioning of body?
5. Breathing- IPPA. SpO2, sounds, chest movement symmetry, cyanosis, respiratory rate.
6. Circulation- BP, pulse, cap refill, skin colour, ECG (check not myocardial ischemia).
7. Disability- AVPU, FAST, GCS, pupils, blood glucose (check for hypo/hyperglycaemia).
8. Examination- temp.
9. Continuously assess ABCD.
10. History: Presenting complaint, history of presenting complaint, associated symptoms, past medical history, current medication, allergies, family history, social history.
11. Any hospital admissions? If no history of asthma, consider Anaphylaxis
12. Accurately document and explain each step to patient.
    Perform PEAK flow (PEFR) before and after nebulised treatment, if possible. 3x in total, highest figure recorded as PEFR value. Care must be taken in a severe attack as it could exacerbate the attack and cause deterioration of the patient.

Question 5

How would you treat an acute severe asthma attack?

Answer 5

TREATMENT (ACUTE SEVERE)
TIME CRITICAL SYMPTOMS- EXTREME DIB OR REQUIREMENT FOR ASSISTED VENTILATIONS, EXHAUSTION, CYANOSIS, SILENT CHEST, SPO2 <92%, PEFR <33% : START CORRECTING ANY ABCD PROBLEMS AND UNDERTAKE TIME-CRITICAL TRANSFER TO HOSPITAL WITH PRE-ALERT, CONTINUE MANAGEMENT EN-ROUTE.
1. Administer high concentration oxygen- 10-15 litres per minute.
2. Administer nebulised salbutamol, 6-9 litres per minute, 5mg in 2.5ml. if COPD is a possibility limit nebulisation with oxygen to 6 minutes.

3. No improvement= Ipratropium bromide nebulise. 500mcg in 2ml, 6-8 litres oxygen. Again, COPD 6 mins.
4. Administer steroids such as prednisolone (8 x 5mg tablets orally = 40mg Contraindications vomiting, unable to swallow, TB, peptic ulcer disease, fungal or worm infections, ocular herpes, suspected or known systemic infection), hydrocortisone (100mg in 1ml over 2 mins IV or IM- contraindications allergy).
5. Continuous salbutamol nebulisation may be administered.
   IF PATIENT BECOMES LIFE-THREATENING:
   • Magnesium sulfate (IV 2g in 10ml over 20 minutes- contraindications known hypermagnesemia)
   • Adrenaline 1:1000 IM only- 500mcg in 0.5ml every 5 mins.

Question 6

Side effects of salbutamol?

Answer 6

Tremor (shaking).
Tachycardia.
Palpitations.
Headache.
Feeling of tension.
Peripheral vasodilatation.
Muscle cramps.
Rash.

Question 7

Side effects of ipratropium bromide?

Answer 7

Nausea.
Dry mouth (common).
Tachycardia/arrhythmia.
Paroxysmal tightness of the chest.
Allergic reaction.