Asthma

Question 1

When to admit a child into ICU for asthma?

Answer 1

Impending respiratory failure (maximal accessory use, exhaustion, poor effort, cyanosis)

Pneumothorax

Requires continuous nebs

Requires salbutamol more frequently than 20 mins after 2 hours

requires nebs more frequently than hourly after 4 hours

Question 2

When can patients be transferred to the ward?

Answer 2

Does not require continous nebs of salbutamol

Received appropriate dose of steroids

Question 3

Describe weaning salbutamol

Answer 3

initial 3 doses 20 min apart

Assess 20 min after 3rd dose

If improving, space out to 40 mins for 4th dose

Then up to 1 hour after last dose

Question 4

Ongoing ward management

Answer 4

IF on IV fluids, limit to 60% maintainence, & measure U & E every 24 hours.
- More frequently if on high dose salbutamol

If on high dose IV or oral steroids, start omeprazole.

Train parents on metered dose inhaler.

Asthma Nurse review

Question 5

Upper and lower limts of RR & HR for age ranges:

• < 1
• 1-2
• 2-5
• 5-12
• > 12

Answer 5

< 1: 30-40 RR, 110-160 HR
1-2: 25-35 RR, 100-150 HR
2-5: 25-30 RR, 95-140 HR
5-12: 15-20 RR, 60-100 HR

Question 6

What is the management of critical asthma exacerabation

Answer 6

Primary assessment. Call ICU registrar

Give O2 to keep sats above 94%

Continous Salbutamol 0.15mg/kg/dose
Check Serum K+

Ipratropium nebs every 20 mins. 125 micograms (for < 6) or 250 micrograms (for > 6). 3 hourly.

IV hydrocortisone 4mg/kg. 6 hourly

Question 7

What if the initial mx of critical asthma exacerbation is still not working?

Answer 7

Give MgSO4 50mg/kg in 5% dextose or saline over 20 mins.

If still deteroriating, give aminophylline (cannot if on oral theophylline). Give 6mg/kg IV over 30 mins

If still deteroriating, IV salbutamol, 5 micrograms/kg/min as a loading dose. Then 1-2 micrograms/kg/min.

Give salbutamol & Amniophylline in separate lines

Question 8

Triad for astham

Answer 8

1. Airway hypersensitivity - causing constriction
2. Bronchial inflammation: oedema, smooth muscle hypertrophy, mucous plugging, epithelial damage
3. Airflow limitation: reversible with tx or spontaneously

Question 9

How to diagnose Astham

Answer 9

Clinically + evidence of variable airflow obstruction.

Question 10

At What age is the PEFR useful?

Answer 10

> 5

Question 11

Signs of life-threatening exacerbations?

Answer 11

33: PEFR < 33% of expected
92: Sats < 92%
C: cyanosis, confused
H: hypoTN
E: exhausted
S: silent chest
T: tachycardia