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EAC Conversion MOD D > EAC Asthma > Flashcards

EAC Asthma Flashcards

1
Q

aetiology (causes) of Asthma

A

Inherited

Modern lifestyles

Smoking during pregnancy

Environmental pollution

Viral infection

Irritants found in the workplace

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2
Q

pathophysiology of asthma

A

Airways almost continuously sensitive and inflamed

Trigger causes bronchospasm

Inflammation increases and mucus secreted

Bronchial muscles

Hyperinflation

Reduction in tidal volume

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3
Q

triggers that can exacerbate asthma

A

Pollen

Exercise

Mould

Cigarette smoke

Dust mites

Stress

Pets

Sudden change in temperature

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4
Q

Clinical features of:

Moderate Asthma Exacerbation

A

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

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5
Q

Clinical features of:

Acute Severe Asthma

A

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+

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6
Q

Clinical features of:

Life Threatening Asthma

A

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
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7
Q

Clinical features of:

Near Fatal Asthma

A

Raised PaCO2 >6kPa and/or requiring mechanical ventilation with raised inflation pressures.

Silent chest

Coma

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8
Q

medical risk factors of:

Near Fatal Asthma

A

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

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9
Q

Psychological/behavioural risk factors of:

Near Fatal Asthma

A

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

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10
Q

How to manage an Asthma Attack

A

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

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11
Q

Remember OB’s

BEFORE AND AFTER TREATMENT

A

Pulse rate

RR

PEF (record the best of 3)

EtCO2 and SpO2

do not delay treatment for severe or life threatening asthma!

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12
Q

how to use an inhaler

A

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.

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13
Q

indications for use:

Salbutamol

A

Acute asthma attack

Expiratory wheezing

Exacerbation of COPD

SOB due to LVF

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14
Q

contra-indications for use:

Salbutamol

A

None in the emergency setting

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15
Q

cautions for use:

Salbutamol

A

Hypertension

Angine

Overactive thyroid

Late pregnancy

Beta blockers

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16
Q

Side effects of:

Salbutamol

A

Tremor

Tachycardia

Palpitations

Headache

Feeling of tension

Peripheral vasodilation

muscle cramps

rash

17
Q

dosage and administration route for:

Salbutamol

A

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

18
Q

Therapeutic effect of:

Salbutamol

A

Selective β2 adrenoreceptor stimulant

Sympathetic (fight/flight) = lungs open

Parasympathetic = lungs closed

19
Q

therapeutic effect of:

Ipratropium Bromide

A

Antimuscarinic bronchodilator

20
Q

indication for use:

Ipratropium Bromide

A

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)

21
Q

contra-indication for use:

Ipratropium Bromide

A

None in the emergency setting

22
Q

cautions for use of:

Ipratropium Bromide

A

Glaucoma

Pregnancy

Prostatic hyperplasia

23
Q

side effects of:

Ipratropium Bromide

A

Headache

Nausea and vomiting

Dry mouth (common)

Difficulty in passing urine and/or constipation

Tachycardia/arrhythmia

Paroxysmal (increase) tightness of chest

Allergic reaction

24
Q

dosage and administration route for:

Ipratropium Bromide

A

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

25
Q

Important note:

Nebulisation and COPD

A

limit nebulisation to 6 minutes

Maintain SpO2 of ≥94%

26
Q

therapeutic effects of:

Adrenaline

A

Sympathomimetic that stimulates both alpha and beta receptors

Relieves bronchospasm in acute severe asthma

27
Q

indications for use:

Adrenaline

A

Life threatening asthma with failing ventilation and continued deterioration despite nebulisation therapy

28
Q

contra-indications for use of:

Adrenaline

A

do not give repeated doses of adrenaline in hypothermic patients

29
Q

cautions for use:

Adrenaline

A

Beta blockers: any drug ending in ‘lol’. cause severe hypertension

Tricyclic antidepressants: amitriptyline, clomipramine, imipramine, lofepramine, nortriptyline

30
Q

side effects of:

Adrenaline

A

none

31
Q

dosage and administration route for:

Adrenaline

A

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

32
Q

IM injection sites

A

Deltoid

Buttock

Outer upper thigh

Front of thigh

33
Q

when can EAC give Adrenaline?

A

on completion and return of their Practice Assessment Document PAD

34
Q

Key points:

Asthma

A

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

EAC Conversion MOD D (33 decks)

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