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CPS Statements > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the lifetime prevalence of asthma in Canadian children?

A

11-16%

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2
Q

What are the most common asthma exacerbation triggers?

A
  1. Viral resp tract infections
    Other triggers include:
  2. Allergen exposure
  3. Suboptimal asthma control at baseline
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3
Q

What are the ED objectives for management of actuate asthma exacerbations?

A
  1. Assessment of severity
  2. Medical intervention
  3. Appropriate disposition
  4. Proper follow up
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4
Q

What are the clinical features of a mild asthma exacerbation?

A
  1. Normal mental status
  2. Normal activity/exertional dyspnea
  3. Normal speech
  4. Minimal IC retractions
  5. Mod wheeze
  6. SpO2 >94% RA
  7. Peak flow >80% personal best
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5
Q

What are the clinical features of a moderate asthma exacerbation (7)?

A
  1. Normal mental status/might looked agitated
  2. Decreases activity or feeding (infant)
  3. Speaks in phrases
  4. Subcostal and IC retractions
  5. Loud pan expiratory and inspiratory wheeze
  6. SpO2 91-94% RA
  7. Peak flow 60-80% personal best
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6
Q

What are the clinical features of a severe asthma exacerbation (6)?

A
  1. Usually agitated
  2. Decreases activity or stops feeding (infant)
  3. Speaks in words
  4. Significant resp distress, all accessory muscle involved, possible nasal flaring or paradoxical thoraco-abdo movement
  5. Wheeze audible without stethoscope
  6. Peak flow
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7
Q

What are the clinical features of impending resp failure (7)?

A
  1. Drowsy or confused
  2. Unable to eat
  3. Unable to speak
  4. Marked resp distress at rest with nasal flare, all accessory muscle use and thoraco-abdo breathing
  5. Silent chest
  6. SpO2
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8
Q

What SpO2 sat is associated with a higher morbidity and risk of hospitalization in asthma exacerbation?

A

SpO2 of 92% or less on presentation

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9
Q

A focused hx in an asthma exacerbation should include?

A
  1. previous medications
  2. Previous life threatening events
  3. Admissions to ICU
  4. Intubations
  5. Deterioration while on systemic corticosteroids
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10
Q

A focused px exam in an asthma exacerbation should include…?

A
  1. Severity of airway obstruction
  2. Accessory muscle use
  3. A/E bilaterally
  4. Wheezing
  5. LOC/alertness
  6. Ability to speak in full sentences
  7. Activity level
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11
Q

List the clinical features of cerebral hypoxemia

A
  1. Mental agitation
  2. Drowsiness
  3. Confusion
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12
Q

An ominous sign of insufficient gas exchange is….?

A

Silent chest

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13
Q

When is a chest X-ray indicated in an asthma exacerbation?

A
  1. Suspected complications ie pneumo
  2. Bacterial pneumonia
  3. FB
  4. Failure to improve despite maximal conventional tx

Otherwise leads to over dx of pneumonia

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14
Q

When is a blood indicated in an asthma exacerbation?

A

No clinical improvement despite max therapy

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15
Q

Signs of impending respiratory failure include…?

A
  1. Silent chest
  2. Normal cap CO2 despite persistent resp distress
  3. Altered LOC
  4. Central cyanosis
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16
Q

What is the preferred method of bronchodilator admin and why?

A

MDI with spacer, because it’s less likely to evoke tachycardia and hypoxemia then nebs (even if on O2, exception is severe impending resp failure)

17
Q

Side effects of salbutamol include…?

A
  1. Tachycardia
  2. Hyperglycaemia
  3. Hypokalemia
    There is a risk of cardiac arrhythmia in adults, but no evidence in kids
18
Q

What is the benefit of antocholinergics in asthma and when should they be used?

A
  1. Better lung function than beta 2 agonists alone
  2. Reduce hospital admission.

Only if used in 1st hour, no evidence after this (Q 20 min for 1st hour)

19
Q

What is the benefit of systemic steroids (PO/IV) in asthma and when should they be used?

A
  1. Reduce hospital admissions
  2. Reduce risk of relapse after initial tx
  3. Earlier d/c from hospital

Should be used in mod to severe exacerbations

20
Q

What is the benefit of MgSo4 in asthma and when should it be used?

A

Used in severe acute asthma (mod to severe) with incomplete response to conventional tx in the 1st 1-2 hrs

  1. Improves resp function
  2. Decreases hospital admissions
21
Q

What is the SE in of MgSo4?

A
  1. Hypotension
  2. Bradycardia

So monitor VS

22
Q

What is the benefit of IV salbutamol in asthma and when should it be used?

A
  1. Improve pulm function and gas exchange

Use in severe asthma of no response to other tx

23
Q

When should IV aminophylline or Heliox be used?

A

In ICU with severe exacerbation that have failed to improve despite max tx (IV steroids, continuous inhaled B2 agonist)

24
Q

List complications of intubation in acute asthma exacerbation?

A
  1. Pneumo
  2. Impaired venous return
  3. Cardiovascular collapse due to increased intra thoracic pressure
25
Q

List admission criteria in an acute asthma exacerbation?

A
  1. Needs O2
  2. Increased WOB persistent
  3. B2 agonist needed more than Q4 h after 4-8 hrs of tx
  4. Deteriorates on systemic steroids
26
Q

List ICU admission criteria in an acute asthma exacerbation?

A

Continuous neb salbutamol and fails to improve

27
Q

List discharge criteria in an acute asthma exacerbation?

A
  1. B2 agonist needed or = 94% RA
  2. Min to no resp distress
  3. Improved A/E
28
Q

Describe d/c instructions and meds for an acute asthma exacerbation?

A
  1. 3-5 day course PO steroids
  2. Ventolin Q4h during exacerbation and then prn
  3. Written asthma action plan
  4. Review techniques for inhaling meds and cleaning device
  5. F/U with GP in 2-4 weeks
29
Q

What is the leading cause of hospitalization in children?

A

Asthma exacerbations

CPS Statements (3 decks)

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