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E1 E2 Paramedic Science > Asthma > Flashcards

Asthma Flashcards

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1
Q

Asthma is…

A

a chronic inflammatory condition of the respiratory system, causing obstruction from mucosal oedema, increase in mucus secretions and bronchospasm.

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2
Q

How many causes of asthma are there?

A

2 - intrinsic and extrinsic

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3
Q

What is an EXTRINSIC cause of asthma?

A
  • Inflammation mediated by systemic IgE production.

- Caused by foreign bodies such as pollen and dust mites

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4
Q

What is an INTRINSIC cause of asthma?

A
  • Inflammation mediated by localised IgE production
  • Triggers unknown, can include exercise, smoking, cold air
  • Triggers stimulate parasympathetic response, causing afferent nerves to be stimulated.
  • Acetylcholine is released from the efferent nerve endings under the lining of the bronchus causing bronchoconstriction
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5
Q

Phase 1 of the two-phase reaction

A

Occurs within minutes

  • Allergen enters mucous membrane
  • Allergen engulfed by dendritic cells, e.g. macrophages
  • Dendritic cells bring allergen antigen to T-helper 2 cells
  • TH2 releases IL-4 (interleukins) and IL-5
  • IL-4: activates plasma cells; stimulating to produce Ig-E antibodies which bind to mast cells
  • IL-5: activates eosinophil
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6
Q

Phase 2 of the two-phase reaction

A

Occurs in 6-8 hours

  • Allergen enters mucous membranes
  • Allergen antigens bind to Ig-E antibodies on mast cells causing them to degranulate
  • Mast cells release inflammatory mediators Histamine and Leukotrienes
  • Activated eosinophils release Leukotrienes, proteases and cytokines
  • Leukotrienes and cytokines attract WBC
  • Histamines and leukotrienes cause; bronchoconstriction
  • increase capillary permeability results in increase mucous production
  • mucosa fills with fluid, eosinophils and inflammatory mediators, resulting in inflamed mucosa
  • increased vascular permeability
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7
Q

NEAR-FATAL asthma signs and symptoms

A

Raised PaCO₂ and/ or requiring mechanical ventilation with raised inflation pressures

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8
Q

LIFE-THREATENING asthma signs and symptoms

A
  • Altered GCS
  • Exhaustion
  • Arrhythmia
  • Hypotension
  • Cyanosis
  • Severe wheeze or ‘Silent Chest’
  • Poor respiratory effort
  • PEF <33% best or predicted
  • SpO₂ <92%
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9
Q

ACUTE SEVERE asthma signs and symptoms

A
  • PEF 33-50% best or predicted
  • Inability to complete sentences in one breath
  • Tachycardia HR >110
  • Increased respiratory rate – tachypnoea RR> 25/min
  • Use of accessory muscles
  • Shortness of breath – dyspnoea
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10
Q

MILD/MODERATE asthma signs and symptoms

A
  • Able to speak in sentences
  • Increasing symptoms
  • PEF > 50-75% best or predicted
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11
Q

Differentials to consider for asthma

A
  • Anxiety attack
  • COPD
  • Anaphylaxis
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12
Q

Risk factors for asthma

A
  • Anaphylaxis
  • Previous asthma attacks
  • Non-compliance with medication
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13
Q

Assessment order

A

DRA(c)BCDE

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14
Q

DANGER/mechanism of injury/catastrophic bleeding assessment for asthma

A
  • Assess for any potential dangers
  • Remove any potential triggers
  • Manage any bleeds
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15
Q

RESPONSE assessment for asthma

A

AVPU - assess

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16
Q

AIRWAY assessment for asthma

A
  • Clear?

* Correct if compromised (consider step-wise approach to airway management if needed)

17
Q

C-SPINE assessment for asthma

A

is this a concern based on MOI?

18
Q

BREATHING assessment for asthma

A 
•	Respiration rate? 
•	Wheeze? (What you looking for?)
•	Accessory muscle use? 
•	Equal and bilateral air entry? 
•	Gain a Peak Expiratory Flow Rate 
•	Assist with ventilation if required
(What about Rate/Rhythm/Depth of breathing? What about IPAP? Thorough respiratory assessment.)
19
Q

CIRCULATION assessment for asthma

A
  • Heart rate?
  • Palpable radial pulse?
  • Capillary refill?
  • Oxygen saturations?
  • Blood pressure?
  • Skin colour- cyanosis
20
Q

DISABILITY assessment for asthma

A
  • Temperature
  • Blood glucose
  • PEARL
  • 12 lead ECG
  • Alerted GCS? PEFR?
21
Q

Treatment of asthma

A

Treat as per JRCALC

- Correct any ABC problems immediately

22
Q

Stepwise Approach for Asthma Treatment (Mild to Near-Fatal)

A
  • Move patient to a calm, quiet environment
  • Encourage use of own inhalers
  • Administer high levels of O2 (what saturations you looking for?)
  • Administer nebulised salbutamol (5mg – 6/8 litres per minute – no max)
  • If no improvement – administer nebulised ipratropium bromide (500mcg – 6/8 litres – max 500mcg)
  • Administer hydrocortisone (100mg injected over 2 mins – max 100mg)
  • Continuous salbutamol nebulisation (unless clinical side effects occur) or if not clinically indicated.
  • Administer adrenaline IM (1:100 – 500mcg – no max)
  • Assess for bilateral tension pneumothorax and treat if present
  • Pre-alert and convey to A&E with continuous management, treatment and assessment.
23
Q

What is the nebulised salbutamol dosage for asthma?

A

5mg – 6/8 litres per minute – no max

24
Q

What is the nebulised ipratropium bromide dosage for asthma?

A

500mcg – 6/8 litres – max 500mcg

25
Q

What is the hydrocortisone dosage for asthma?

A

100mg injected over 2 mins – max 100mg

26
Q

What is the IM adrenaline dosage for asthma?

A

1:100 – 500mcg – no max

E1 E2 Paramedic Science (8 decks)

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