Asthma

Question 1

An improvement in SPO2…?

Answer 1

May not be a sign of improvement in pt condition.

Question 2

Beware of the pt…

Answer 2

presenting with wheeze associated with heart failure and no asthma/COPD history.

Question 3

In patients with mild or moderate respiratory distress what is the preferred route of Salbutamol admin?

Answer 3

via pMDI, if not available nebulise 5mg Salbutamol at 20min intervals as required.

Question 4

What is the management for Mild or Moderate Respiratory Distress in asthma?

Answer 4

Salbutamol pMDI + spacer, 4-12 doses with 4 breaths per dose at 20 min intervals until resolution of symptoms.

Question 5

When should Mild to Moderate asthma be Rx as per Severe?

Answer 5

If no significant response after 20mins.

Question 6

What is the management for Severe Asthma?

Answer 6

Salbutamol 10mg (5mL), nebulised
Ipratropium Bromide 500mcg (2mL), nebulised
Dexamethasone 8mg IV/Oral

Rpt. Salbutamol 5mg (2.5mL) at 5min intervals as req.

Question 7

What is considered an “Inadequate Response”?

Answer 7

No response to nebulised therapy or speaking single words/acute life threat present.

Question 8

How is an Inadequate Response to Severe Asthma Therapy managed?

Answer 8

Adrenaline 500mcg IM,
- Rpt. 500mcg IM every 5 - 10mins.
If no response to IM Adrenaline, consult the clinician for:
20mcg IV Adrenaline
- Rpt. 20mcg every 2 mins

Question 9

At what point will the pt require assisted ventilation, and how should this be done?

Answer 9

If becomes unconscious with poor/no ventilation but still has cardiac output.
6 -7 mL/kg @ 5 - 8 ventilations per minute.
Will require moderately high respiratory pressures.
Allow for prolonged expiratory phase.

Question 10

What is the benefit of allowing a period of apnoea in the asthmatic patient who has lost C.O?

Answer 10

Allows a reduction in gas trapping, decreasing intrathoracic pressure, improving venous return and potentially cardiac output.

Question 11

When is a period of apnoea indicated?

How long should it go for, and what needs to be done concurrently.

Answer 11

When the pt loses C.O, especially during assisted ventilation when the bag becomes stiff.

1 min, prepare for potential resuscitation.

Question 12

After a period of apnoea, what are the 3 potential outcomes and their subsequent management?

Answer 12

1. Cardiac output returns - Rx as per Severe
2. Carotid pulse, no BP - (MICA) IV Adrenaline, NS 20ml/kg
3. No return of output - Mx as per Cardiac Arrest