Asthma Flashcards
What are the features to note on an assessment of a patient with asthma?
Altered conscious state, accessory muscle use/recession, talking?, wheeze, central cyanosis, sats, pulse, PEFR/FEV1, pulsus paradoxus.
What are the doses of salbutamol MDI?
Child <6 years: 6 puffs (= 600 mcg)
Child >6 years: 12 puffs (= 1200 mcg)
Describe your management for severe paeds asthma.
Every 20 minutes for 3x.
Salbutamol MDI (6 or 12 puffs depending on age)
+
Ipratropium MDI (4 or 8 puffs depending on age)
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Oral pred 2 mg/kg stat OR IV methylpred (1 mg/kg; max 60 mg) Q6H
Discuss IV salbutamol.
5 mcg/kg/min for 1 hour as a load followed by 1-2 mcg/kg/min infusion. Limited evidence.
What are the neb doses of ipratropium for children?
Child <6 years: 125 mcg/neb
Child >6 years: 250 mcg
What is the dose of oral prednisolone in asthma?
2 mg/kg (60 mg max) initially, only continuing with 1 mg/kg daily for further 1-2 days if there is ongoing need for regular salbutamol
Discuss magnesium sulfate in asthma.
Use mag sulfate 50%; 500 mg/ml = 2 mmol/mL. Give 0.2 mmol/kg over 20 mins (max 8 mmol) + consider infusion 0.12 mmol/kg/hr.
How do you manage critical asthma.
Oxygen, continuous salbutamol, nebulised ipratropium, methylpred, aminophylline, magnesium, IV salbutamol. Consider IM/IV adrenaline. Respiratory support.
What are the doses of ipratropium MDI?
20 mcg per actuation
Child <6 years: 4 puffs
Child >6 years: 8 puffs
Describe moderate asthma.
Normal GCS, talking in phrases. Minimal accessory muscle use and mod/loud wheeze. No central cyanosis, sats 90-94% and pulse a little elevated +/- pulsus paradoxus. FEV1 40-60% of predicted.
Discuss aminophylline in paediatric asthma.
Loading dose: 10 mg/kg (max 500 mg) over 60 mins
Describe your management for moderate paeds asthma.
Every 20 minutes for 3x.
Salbutamol MDI (6 or 12 puffs depending on age)
+
Oral pred 2 mg/kg stat + 1 mg/kg for 1-2 further days
What can you say about the administration of aminophylline, magnesium and salbutamol?
They must be given through separate IV lines.
Describe severe/critical asthma.
Agitated, confused or drowsy. Mod/severe accessory muscle use and unable to speak/speaking in words only. Quiet chest with sats <90% and elevated HR. Unable to perform FEV1/PEFR and pulsus paradoxus present.
Describe your management for mild paeds asthma.
6 puffs of salbutamol MDI (<6 years) or 12 puffs (>6 years). May only be required once…
What are the neb doses for salbutamol for children?
Child <6 years: 2.5 mg
Child >6 years: 5 mg
What are the life threatening features of asthma?
Silent chest, cyanosis, poor respi effort, hypotension, exhaustion, confusion, coma
Describe mild asthma.
Normal GCS, no accessory muscle use, talking in sentences. Variable wheeze with no central cyanosis. Normal sats >94%, pulse age appropriate and FEV1 >60% predicted. No pulsus paradoxus.
