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TCA 2 - Asthma > Asthma exacerbations > Flashcards

Asthma exacerbations Flashcards

1
Q

What is an acute asthma exacerbation?

A
  • Worsening of asthma symptoms
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2
Q

What are the symptoms of an acute asthma exacerbation?

A
  • Cough
  • Wheezing
  • Dyspnoea
  • Chest tightness
  • Sleep disturbance
  • Accessory muscle use
  • Tachypnoea
  • Tachycardia
  • Inability to speak
  • Cyanosis
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3
Q

What assessments would you do in a primary care setting for someone showing an acute asthma exacerbation?

A
  • HR
  • Respiratory rate
  • Oxygen saturation
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4
Q

What investigations would you order in an acute asthma exacerbation?

A
  • PEFR
  • Oxygen saturation
  • ABG
  • CXR
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5
Q

What would a PEFR result show in an acute asthma attack?

A

Measure as a percentage of their best predicted

  • 50-33% = acute asthma attack
  • <33% = life-threatening
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6
Q

What would an oxygen saturation result possibly show in an acute asthma attack?

A

<92% = life-threatening

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7
Q

What should you aim for regarding oxygen saturation?

A

94-98%

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8
Q

When would you order an ABG test?

A

When oxygen saturation is <92%

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9
Q

What would an ABG result possibly show in an acute asthma attack?

A
  1. Initially respiratory alkalosis
    Tachypnoea causes a decrease in CO2
  2. Normal CO2 or hypoxia
    Concerning as indicates patient is tiring and life-threatening asthma
  3. Respiratory acidosis
    Increase in CO2
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10
Q

What would an CXR result possibly show in an acute asthma attack?

A

Hyperinflation

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11
Q

What is a CXR useful for?

A

Identification of co-existing conditions and to rule out others

  • Congestive HF
  • Foreign body aspiration
  • Pneumothorax
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12
Q

What does moderate acute asthma look like?

A
  • Increasing symptoms
  • PEF >50-75% best or predicted
  • No features of acute severe asthma
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13
Q

What does acute severe asthma look like?

A
  • PEF 33-50% best or predicted
  • Respiratory rate ≥ 25/min
  • HR ≥ 110/min
  • Inability to complete sentences in one breath
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14
Q

What does life-threatening asthma look like?

A
  • PEF <33% best or predicted
  • SpO2 <92%
  • ABG:
    PaO2 <8kPa
    ‘Normal’ PaCO2 (4.6-6.0kPa)
  • Altered conscious level
  • Exhaustion
  • Arrhythmia
  • Hypotension
  • Cyanosis
  • Silent chest
  • Poor respiratory effort
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15
Q

What does near-fatal asthma look like?

A
  • Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures
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16
Q

What are the aims of treatment of an acute severe asthma attack?

A
  • Relieve airflow obstruction

- Prevent further relapses

17
Q

What could a patient do in a non-medical setting to treat an acute severe asthma attack?

A

4 puffs of salbutamol initially, then 2 puffs every 2 minutes of salbutamol through spacer

18
Q

What would you give a patient in a primary care setting to treat an acute severe asthma attack?

A
  1. Inhaled SABA and O2 with nebuliser or spacer
  2. Steroids
    IV Hydrocortisone 100mg or Oral (PO) prednisolone 40-50mg
  3. Insert IV cannula
    For useful drugs if needed
  4. Give inhaled ipratropium bromide combined with the
    SABA if asthma life-threatening, severe or poor response to initial SABA
  5. Sit them upright
  6. Document all treatments
    Times, routes and doses
19
Q

What is the criteria for admission to hospital with asthma?

A
  • Life-threatening or near-fatal asthma attack

- Severe asthma attack persisting after treatment

20
Q

What additional medications might you give a patient in hospital to treat an acute severe asthma attack?

A
  • IV magnesium sulphate
    If not had a good initial response to therapy
  • IV aminophylline
    Consultation with senior medical staff
21
Q

What is the criteria for non-invasive ventilation and admission to ICU?

A

Hypercapnic respiratory failure

22
Q

What must you continue to measure during an acute severe asthma attack?

A 
- PEFR
      15-30 mins after starting treatment
- O2 saturation
- Repeat ABG
- HR
- Respiratory rate
23
Q

What must you measure during an acute severe asthma attack if there are no signs of improvement?

A
  • Serum potassium
    Salbutamol can cause potassium absorption into cells
  • Blood glucose
  • Serum theophylline
    Only if aminophylline is continued >24hrs
24
Q

After an acute severe asthma attack, what medication should be continued until recovery?

A

Prednisolone (40-50mg) daily for minimum 5 days

25
Q

What are the stages of stepping up bronchodilators?

A
  1. Inhaled/nebulised salbutamol
  2. Inhaled/nebulised ipratropium bromide
  3. IV magnesium sulphate
  4. IV salbutamol
  5. IV aminophylline

If not got control by this point -> intubate and ventilate

TCA 2 - Asthma (8 decks)

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