Asthma

Question 1

What is asthma

Answer 1

• long term respiratory condition
• chronic bronchial inflammation, increased mucus production and tissue oedema
• episodes of acute bronchial hypersensitivity and bronchoconstriction
• patient present as breathlessness, wheezing and coughing

Question 2

What causes wheeze in asthmatic pt

Answer 2

Reduced lumen size from acute bronchoconstriction and tissue oedema causes air to become trapped in the lungs

The increased airway resistance results in expiratory wheeze

Question 3

Typical presentation asthma

Answer 3

Wheeze
Breathlessness
Cough
Tight chest

Question 4

Warnings

Answer 4

• all asthma attacks should be considered severe until severity is assessed
• they’re not associated with rash / facial swelling (anaphylaxis)
• if acute severe / life threatening asthma, may not be distressed or have any of the typical features

Question 5

Moderate asthma

Respiratory rate
Heart rate
Oxygen saturations
Peak expiratory flow
Other indications

Answer 5

Respiratory rate: less than than 25bpm
Heart rate: less than 110 bpm
Oxygen saturations: more than 92%
Peak expiratory flow: between 50-75% of best/expected
Other indications: increasing symptoms (speech normal)

Question 6

Acute severe asthma

Respiratory rate
Heart rate
Oxygen saturations
Peak expiratory flow
Other indications

Answer 6

Respiratory rate: 25bpm or more
Heart rate: 110 bpm or more
Oxygen saturations: more than 92%
Peak expiratory flow: between 33-50% of best/expected
Other indications: inability to compete fulls sentences

Question 7

Life threatening asthma

Respiratory rate
Heart rate
Oxygen saturations
Peak expiratory flow
Other indications

Answer 7

Respiratory rate: 25bpm or more
Heart rate: arrhythmia
Oxygen saturations: less than 92%
Peak expiratory flow: less than 33% of best/expected
Other indications: cyanosis, altered consciousness, poor respiratory effort

Question 8

ABCDE assessment of asthma

Answer 8

A - wheeze
B - increased respiratory rate // reduced peak flow // hypoxia
C - high heart rate // arrhythmia
D - anxiety // conscious level may deteriorate
E - increased respiratory effort // cyanosis

Question 9

Asthma management

Answer 9

Salbutamol inhalers
10 doses of salbutamol may be administered in a 10-20min period
Initial loading dose of 4 activations should be provided

x4, x2, x2, x2

Question 10

Oxygen therapy

Answer 10

Pulse oximeter is used to assess oxygen saturations

Below 94% = hypoxia

For pt act high risk of hyper apnea below 88% = hypoxia

Hypoxic pt should be treated with oxygen

Question 11

Low risk of hypercapnia treatment

Answer 11

Treat: Less than 94%
Administer: 5-10L/min
Via: simple face mask
Target: 94-98%
Other: if Sp02 les than 85%, give 15 via non-rebreather mask

Question 12

High risk of hypercapnia treatment

Answer 12

Treat: less than 88%
Administer: 1-2L/min
Via: nasal cannula
Target: 88-92%
Other: check for ALERT cards