Asthma

Question 1

What are the features to note on an assessment of a patient with asthma?

Answer 1

Altered conscious state, accessory muscle use/recession, talking?, wheeze, central cyanosis, sats, pulse, PEFR/FEV1, pulsus paradoxus.

Question 2

What are the doses of salbutamol MDI?

Answer 2

Child <6 years: 6 puffs (= 600 mcg)

Child >6 years: 12 puffs (= 1200 mcg)

Question 3

Describe your management for severe paeds asthma.

Answer 3

Every 20 minutes for 3x.

Salbutamol MDI (6 or 12 puffs depending on age)
+
Ipratropium MDI (4 or 8 puffs depending on age)
+
Oral pred 2 mg/kg stat OR IV methylpred (1 mg/kg; max 60 mg) Q6H

Question 4

Discuss IV salbutamol.

Answer 4

5 mcg/kg/min for 1 hour as a load followed by 1-2 mcg/kg/min infusion. Limited evidence.

Question 5

What are the neb doses of ipratropium for children?

Answer 5

Child <6 years: 125 mcg/neb

Child >6 years: 250 mcg

Question 6

What is the dose of oral prednisolone in asthma?

Answer 6

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

Question 7

Discuss magnesium sulfate in asthma.

Answer 7

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.

Question 8

How do you manage critical asthma.

Answer 8

Oxygen, continuous salbutamol, nebulised ipratropium, methylpred, aminophylline, magnesium, IV salbutamol. Consider IM/IV adrenaline. Respiratory support.

Question 9

What are the doses of ipratropium MDI?

Answer 9

20 mcg per actuation
Child <6 years: 4 puffs
Child >6 years: 8 puffs

Question 10

Describe moderate asthma.

Answer 10

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.

Question 11

Discuss aminophylline in paediatric asthma.

Answer 11

Loading dose: 10 mg/kg (max 500 mg) over 60 mins

Question 12

Describe your management for moderate paeds asthma.

Answer 12

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

Question 13

What can you say about the administration of aminophylline, magnesium and salbutamol?

Answer 13

They must be given through separate IV lines.

Question 14

Describe severe/critical asthma.

Answer 14

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.

Question 15

Describe your management for mild paeds asthma.

Answer 15

6 puffs of salbutamol MDI (<6 years) or 12 puffs (>6 years). May only be required once…

Question 16

What are the neb doses for salbutamol for children?

Answer 16

Child <6 years: 2.5 mg

Child >6 years: 5 mg

Question 17

What are the life threatening features of asthma?

Answer 17

Silent chest, cyanosis, poor respi effort, hypotension, exhaustion, confusion, coma

Question 18

Describe mild asthma.

Answer 18

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.