EAC Asthma Flashcards
aetiology (causes) of Asthma
Inherited
Modern lifestyles
Smoking during pregnancy
Environmental pollution
Viral infection
Irritants found in the workplace
pathophysiology of asthma
Airways almost continuously sensitive and inflamed
Trigger causes bronchospasm
Inflammation increases and mucus secreted
Bronchial muscles
Hyperinflation
Reduction in tidal volume
triggers that can exacerbate asthma
Pollen
Exercise
Mould
Cigarette smoke
Dust mites
Stress
Pets
Sudden change in temperature
Clinical features of:
Moderate Asthma Exacerbation
Able to talk in full sentences
SpO2 ≥92%
PEFR ≥50%-75% best predicted
hear rate:
≤140/min 2-5yrs
≤125/min 5+
RR:
≤40/min 2-5yrs
≤30/min 5+
NO FEATURES OF ACUTE SEVERE ASTHMA
Clinical features of:
Acute Severe Asthma
Any one of the following:
Cant complete sentences in one breath or too breathless to talk/feed
PEFR 33%-50% of best predicted
heart rate:
>140/min 2-5yrs
≥110/min 5+
RR:
>40/min 2-5yrs
≥25/min 5+
Clinical features of:
Life Threatening Asthma
Any one of the following in a patient with severe Asthma:
Altered level of conciousness Exhaustion Arrhythmia Hypotension Cyanosis Silent chest Poor respiratory effort PEF
Clinical features of:
Near Fatal Asthma
Raised PaCO2 >6kPa and/or requiring mechanical ventilation with raised inflation pressures.
Silent chest
Coma
medical risk factors of:
Near Fatal Asthma
Previous near fatal asthma
previous hosp adm. from asthma especially in last yr, requiring 3 or more classes of asthma meds
Heavy use of β2 agonist
Repeated ED attendance for asthma care especially in last year
> 12 reliever inhalers in a year
Brittle asthma
Psychological/behavioural risk factors of:
Near Fatal Asthma
Non-compliance with treatment or monitoring
Failure to attend appointments
Fewer GP contacts
Frequent home visits
Self discharge from hospital
Psychiatric illness or self harm
Current or recent major tranquilliser use
Denial
Alcohol or drug abuse
Obesity
Learning difficulties
Employment problems
Social isolation
Childhood abuse
Severe domestic, marital or legal stress
How to manage an Asthma Attack
Move to calm, quiet environment
Encourage use of own inhaler - preferably using spacer.
2 puffs every 2 minutes to a max of 10 puffs.
High % oxygen therapy
Consider nebulised salbutamol
consider nebulised ipratropium bromide
continue with salbutamol neb unless clinically significant side effects occur
Consider administering adrenaline
Consider positive pressure ventilation using BVM and T-peice
Remember OB’s
BEFORE AND AFTER TREATMENT
Pulse rate
RR
PEF (record the best of 3)
EtCO2 and SpO2
do not delay treatment for severe or life threatening asthma!
how to use an inhaler
Remove cap and shake
Breathe out gently
Put mouthpiece in mouth and as you begin to breathe in, which should be slow and deep, press canister down and continue to inhale steadily and deeply.
Hold breath for 10 seconds, or as long as is comfortable.
For a second dose wait for approximately 30 seconds.
Only use the device for the number of doses on the label, then start a new inhaler.
indications for use:
Salbutamol
Acute asthma attack
Expiratory wheezing
Exacerbation of COPD
SOB due to LVF
contra-indications for use:
Salbutamol
None in the emergency setting
cautions for use:
Salbutamol
Hypertension
Angine
Overactive thyroid
Late pregnancy
Beta blockers
Side effects of:
Salbutamol
Tremor
Tachycardia
Palpitations
Headache
Feeling of tension
Peripheral vasodilation
muscle cramps
rash
dosage and administration route for:
Salbutamol
with 6-8L/min oxygen
Adults ≥12yrs 5mg nebulised
Children ≥6yrs-≤11yrs 5mg nebulised
Birth-≤5yrs 2.5mg nebulised
repeated as necessary
ALWAYS CROSS CHECK POCKET BOOK FOR DOSAGE AND ROUTES. THEN CROSSCHECK WITH CREW MATE
Therapeutic effect of:
Salbutamol
Selective β2 adrenoreceptor stimulant
Sympathetic (fight/flight) = lungs open
Parasympathetic = lungs closed
therapeutic effect of:
Ipratropium Bromide
Antimuscarinic bronchodilator
indication for use:
Ipratropium Bromide
Acute severe or life threatening asthma
Acute asthma unresponsive to salbutamol
Exacerbation of COPD unresponsive to salbutamol (if COPD a possibility limit neb to six minutes)
contra-indication for use:
Ipratropium Bromide
None in the emergency setting
cautions for use of:
Ipratropium Bromide
Glaucoma
Pregnancy
Prostatic hyperplasia
side effects of:
Ipratropium Bromide
Headache
Nausea and vomiting
Dry mouth (common)
Difficulty in passing urine and/or constipation
Tachycardia/arrhythmia
Paroxysmal (increase) tightness of chest
Allergic reaction
dosage and administration route for:
Ipratropium Bromide
With 6-8L/min oxygen
Adult ≥12yrs 500mcg nebulised
18 months - ≤11yrs 250mcg nebulised
1 month - ≤18 months 125-250mcg nebulised
Given once only
concurrent with 1st dose of salbutamol in sever or life threatening asthma
concurrent with 2nd or later dose salbutamol in unresponsive COPD or Asthma
ALWAYS CROSS CHECK POCKET BOOK FOR DOSAGE AND ROUTES. THEN CROSSCHECK WITH CREW MATE
Important note:
Nebulisation and COPD
limit nebulisation to 6 minutes
Maintain SpO2 of ≥94%
therapeutic effects of:
Adrenaline
Sympathomimetic that stimulates both alpha and beta receptors
Relieves bronchospasm in acute severe asthma
indications for use:
Adrenaline
Life threatening asthma with failing ventilation and continued deterioration despite nebulisation therapy
contra-indications for use of:
Adrenaline
do not give repeated doses of adrenaline in hypothermic patients
cautions for use:
Adrenaline
Beta blockers: any drug ending in ‘lol’. cause severe hypertension
Tricyclic antidepressants: amitriptyline, clomipramine, imipramine, lofepramine, nortriptyline
side effects of:
Adrenaline
none
dosage and administration route for:
Adrenaline
Adult ≥12yrs 500mcg IM
Children 6-11yrs 300mcg IM
Birth - 5yrs 150mcg IM
repeat after 5 mins if clinically indicated
ALWAYS CROSS CHECK POCKET BOOK FOR DOSAGE AND ROUTES. THEN CROSSCHECK WITH CREW MATE
IM injection sites
Deltoid
Buttock
Outer upper thigh
Front of thigh
when can EAC give Adrenaline?
on completion and return of their Practice Assessment Document PAD
Key points:
Asthma
Asthma is a common life-threatening condition
Its severity is often not recognised
Accurate documentation is essential
A silent chest is a pre-terminal sign
