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
List admission criteria in an acute asthma exacerbation?
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
List ICU admission criteria in an acute asthma exacerbation?
Continuous neb salbutamol and fails to improve
27
List discharge criteria in an acute asthma exacerbation?
1. B2 agonist needed or = 94% RA 3. Min to no resp distress 4. Improved A/E
28
Describe d/c instructions and meds for an acute asthma exacerbation?
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
What is the leading cause of hospitalization in children?
Asthma exacerbations