Asthma Exacerbation

Question 1

What is an asthma exacerbation?

Answer 1

Asthma attack, an acute worsening of inflammation, airway restriction and obstruction.

Question 2

What are symptoms of asthma exacerbation?

Answer 2

Wheezing and increasing difficulty breathing
Chest tightness
Cough +- sputum
Symptoms worse at night because circadian related increased bronchial muscle tone around 3-4 AM

Question 3

What are clinical findings of asthma exacerbation/

Answer 3

Visible dyspnea
Audible wheezing
Prolonged expiration
Accessory muscle use
Tripod position
pursed lips
Decreased breath sounds

Question 4

What does a pt’s blood gas look like during a milld asthma exacerbation?

Answer 4

ABG

Mild: Normal or respiratory alkalosis due to hyperventilation
Decreased CO2
Elevated pH
SPO2= normal
PaO2= normal or increased

Question 5

What does a pt’s blood gas look like during a moderate asthma exacerbation?

Answer 5

Respiratory alkalosis
Patient is hyperventilating
Decreased CO2
Elevated pH
Both SPO2 and PaO2 elevated

Question 6

What does a pt’s blood gas look like during a severe asthma exacerbation?

Answer 6

Respiratory acidosis
Greatly increased CO2
Decreased pH
Decreased SPO2 and PaO2

RESPIRATORY ARREST

Question 7

What is emergent treatment for asthmatics?

Answer 7

They usually have used their rescue SABA multiple times.

Apply O2 and bridge ventilation

Repeated SABA and SAMA
(Albuterol and ipratropium) nebulized or MDI w/ spacer

Corticosteroids oral or IV

Not responding- IV magnesium, intubate

Question 8

What do we use to monitor a patient’s response to emergent treatment?

Answer 8

Clinical status
Vitals- walks of life
PEF if =< 50% predicited= severe still
Serum CO2

Most pts will show improvements in the first 24-48 hours.

Question 8

What do we use to monitor a patient’s response to emergent treatment?

Answer 8

Clinical status
Vitals- walks of life
PEF if =< 50% predicited= severe still
Serum CO2

Most pts will show improvements in the first 24-48 hours.

Question 9

When should a patient transition to the ICU?

Answer 9

Intubate:
- Slowing respiratory rate
- depressed mental status
- inability to maintain respiratory effort
- worsening hypercapnia and associated respiratory acidosis
- SO2 <92% with a face mask at 100% O2

Question 10

When do we refer chronic management?

Answer 10

Uncertain of diagnosis
uncontrolled
frequent exacerbations
Step 4-5 of asthma step management
Side effects of meds are intolerable

Question 11

Do kids grow out of their asthma?

Answer 11

No, airways increase in diameter reducing airway resistance.
Reoccurrance 30-40 years old