Asthma Exacerbation- Inpatient Setting Treatment and Assessment Flashcards
Initial assessment of a patient in the inpatient setting for an acute asthma exacerbation
Exactly the same as outpatient, but you also look at these two things:
Fatigue and somnolence- airway intervention may be needed
ABG if FEV1 is <50% predicted or not responding to treatment/deteriorating
ABC of assessment
Airway, breathing, circulation
If drowsiness, confusion, silentt chest are present inpatient, what do you do?
Consult ICU, start SABA and O2, and prepare for intubation because this could be a severe exacerbation
If drowsiness, confusion, and a silent chest aren’t present inpatient, what do you do?
Triage by clinical status according to the worst feature
Treatment of mild or moderate asthma exacerbation inpatient
SABA
CONSIDER ipratropium bromide
Controlled O2 to maintain saturation
PO corticosteroids
SABA dosing inpatient for asthma exacerbation
MDI: 4-8 puffs q30min up to 4 hours, then q1-4h PRN
Neb: 2.5-5mg q20min x3 doses, then q1-4h PRN
Duration of action for SABA
2-4 hours
Prednisone dosing for inpatient asthma exacerbation
50mg PO QD x5-7 days
Prednisone clinical pearls for inpatient asthma exacerbation
PO preferred unless patient is vomiting, intubated, somnolence present
Onset is 4 hours until improvement
Oxygen dosing for inpatient exacerbation
Titrate to response of an O2 sat of 94-98%
Treatment of SEVERE asthma exacerbation inpatient
Same as mild to moderate, but with some additional choices:
Ipratropium bromide
IV corticosteroids
IV magnesium
Consider high-dose ICS
Where are ipratropium, magnesium, ICS used in severe asthma exacerbation?
ED only
Ipratropium severe asthma exacerbation dosing
MDI: 8 puffs every 20 minutes PRN up to 3 hours
Neb: 500mcg q30mins x3 doses, then q2-4h PRN
IV Mg dosing
2gm IV x1
Magnesium clinical pearls
Used if there’s a failure to respond to initial treatment or have persistent hypoxemia where the FEV1 is <25-30%
When to give a high ICS
Within 1 hour
High-dose ICS clinical pearls for inpatient severe asthma exacerbation
Can reduce the need for admission if systemic steroids aren’t given
If admitted, it should be started or continued
SHOULD BE GIVEN ON DISCHARGE HOME
Assessing progress for severe asthma exacerbation inpatient
Measure lung function in all patients 1 hours after initial treatment
When to consider a patient with severe asthma exacerbation for discharge
FEV1 or PEF 60-80% of predicted or personal best and symptoms have improved
When to continue treatment and not consider the patient for discharge
FEV1 or PEF <60% of predicted or personal best or lack of clinical response
Treatment on discharge for an inpatient asthma exacerbation
Inhaled ICS, OCS, reliever, vaccinations
Treatment on discharge: inhaled ICS
If the patient isn’t on one, add an ICS
If they are already on one, step up therapy for 2-4 weeks
Treatment on discharge: OCS
5-7 day total dose, re-evaluation should occur prior to D/C
Treatment on discharge: reliever
Transition patient back to PRN outpatient regimen
D/C ipratropium if the patient was on it
