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Medical/Surgical Protocols 2016 > M4 - Asthma > Flashcards

M4 - Asthma Flashcards

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USMLE® Step 1 flashcards
1
Q

Treatment:

  1. ____ (__)
  2. Assess ____ and ____ ___ ___ ___ (____ - Patients ____ years of age)
  3. Check for ____/____ ____
  4. Administer _____/s if indicated. Note: ____ ____ (____) should only be administered to patients with moderate to severe asthma as an adjunct to ____. ____ and ____ must not be given to people with asthma who are in ____ ____.
  5. ____ ___ if indicated (skill 102.7)
  6. ____ ____ (__) for all patients with ____/____ ____ asthma
  7. Regularly repeat and document ____ ____ ____ and ____ ____ in order to identify trends in clinical deterioration
A
  1. Patient care (A2)
  2. Severity; Peak Expiratory Flow Rate (PEFR); >=8
  3. Pneumothorax/Tension pneumothorax
  4. Medication/s; Ipratropium Bromide (Attrovent); Salbutamol; Analgesics; Sedatives; Respiratory distress.
  5. Expiratory assistance
  6. Urgent transport (A8); severe/life threatening
  7. ABCD physical examinations; physiological observations
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2
Q

Protocol specific exclusions (9)

A
  • Initial moderate or severe/life threatening presentation
  • Previous intubation/ICU admission for asthma
  • Initial PEFR <75% predicted or known physiological value
  • Concurrent respiratory illness
  • Bilateral crepitation on auscultation
  • History of COPD or heart failure
  • Nil improvement in PEFR and/or symptomatic post treatment
  • No access to self-administered bronchodilator
  • Pregnancy
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3
Q

Mild asthma symptoms: Patients >= 16yo

  • Physical exhaustion
  • Talks in
  • Heart rate
  • Central cyanosis
  • Wheeze intensity
  • PEFR
  • SpO2 on presentation
A
  • Physical exhaustion: No
  • Talks in: Sentences
  • Heart rate: <100/min
  • Central cyanosis: Absent
  • Wheeze intensity: Variable
  • PEFR: >75% predicted (or best if known)
  • SpO2 on presentation: (blank)
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4
Q

Moderate asthma symptoms: Patients >= 16yo

  • Physical exhaustion
  • Talks in
  • Heart rate
  • Central cyanosis
  • Wheeze intensity
  • PEFR
  • SpO2 on presentation
A
  • Physical exhaustion: No
  • Talks in: Phrases
  • Heart rate: 100-120/min
  • Central cyanosis: May be present
  • Wheeze intensity: Moderate to loud
  • PEFR: 50-75% predicted (or best if known)
  • SpO2 on presentation (blank)
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5
Q

Severe/Life Threatening asthma symptoms: Patients >= 16yo

  • Physical exhaustion
  • Talks in
  • Heart rate
  • Central cyanosis
  • Wheeze intensity
  • PEFR

Note
- SpO2 on presentation

A
  • Physical exhaustion: Yes - Paradoxical chest movement may be present
  • Talks in: Words
  • Heart rate: >120/min - may be bradycardic when respiratory arrest is imminent
  • Central cyanosis: Likely to be present
  • Wheeze intensity: Often quiet
  • PEFR: <50% predicted (or best if known), or <100L/min - may be incapable of performing test.
  • SpO2 on presentation: <90% Cyanosis may be present

Note: Any of these features indicates that the episode is severe, the absence of any feature does not exclude a severe attack.

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6
Q

Mild asthma symptoms: Patients < 16yo

  • Altered LOC
  • Talks in
  • Heart rate
  • Central cyanosis
  • Wheeze intensity
  • PEFR**
  • SpO2 on presentation
  • Accessory muscle
A
  • Altered LOC: No
  • Talks in: Sentences
  • Heart rate: <100/min
  • Central cyanosis: Absent
  • Wheeze intensity: Variable
  • PEFR**: >60% predicted (or best if known) - Children <7yo are unlikely to be able to perform PEFR or spirometry reliably during an acute episode.
  • SpO2 on presentation: >94%
  • Accessory muscle: None
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7
Q

Moderate asthma symptoms: Patients < 16yo

  • Altered LOC
  • Talks in
  • Heart rate
  • Central cyanosis
  • Wheeze intensity
  • PEFR**
  • SpO2 on presentation
  • Accessory muscle
A
  • Altered LOC: No
  • Talks in: Phrases
  • Heart rate: 100-200/min
  • Central cyanosis: Absent
  • Wheeze intensity: Moderate to loud
  • PEFR**: 40-60% predicted (or best if known) - Children <7yo are unlikely to be able to perform PEFR or spirometry reliably during an acute episode.
  • SpO2 on presentation: 90-94%
  • Accessory muscle: Mild-moderate
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8
Q

Severe/Life Threatening asthma symptoms: Patients < 16yo

  • Altered LOC
  • Talks in
  • Heart rate
  • Central cyanosis
  • Wheeze intensity
  • PEFR**
  • SpO2 on presentation
  • Accessory muscle
A
  • Altered LOC: Agitated, confused, drowsy
  • Talks in: Words, unable to speak
  • Heart rate: >200/min - bradycardia may be seen if respiratory arrest is imminent
  • Central cyanosis: Likely to be present
  • Wheeze intensity: Often quiet
  • PEFR**: <40% predicted (or best if known) or unable to perform - Children <7yo are unlikely to be able to perform PEFR or spirometry reliably during an acute episode.
  • SpO2 on presentation: <90%
  • Accessory muscle: Moderate-severe
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9
Q

Medication for Mild Asthma
Medication, route
Adult age, dose, repeat, max
Paediatric age, dose, repeat, max

A

Salbutamol (216) - via neb and O2 8L/min
>= 5yo: 5mg, repeat as indicated, no max
<5yo: 2.5mg, repeat as indicated, no max

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10
Q 
Medication for Moderate Asthma
Medication, route
Adult dose, repeat, max
Paediatric dose, repeat, max
X 3 medications
A

Salbutamol (216) - via neb and O2 8L/min
>= 5yo: 5mg, repeat as indicated, no max
<5yo: 2.5mg, repeat as indicated, no max

Ipratropium Bromide (223) - via neb and O2 8L/min
>= 6yo: 500mcg, repeat once, max 2 doses
<6yo: 250mcg, repeat once, max 2 doses

Hydrocortisone (238) - 100mg vial reconstituted with 2mL normal saline 0.9% (50mg:1mL); IM/IV
>= 16yo: 100mg, no repeat, max 1 dose
6-<16yo: 4mg/kg, max bolus 100mg, no repeat, max 1 dose

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11
Q 
Medication for Severe/Life Threatening Asthma
Medication, route
Adult dose, repeat, max
Paediatric dose, repeat, max
X 4 medications
A

Salbutamol (216) - via neb and O2 8L/min
>= 5yo: 5mg, repeat as indicated, no max
<5yo: 2.5mg, repeat as indicated, no max

Ipratropium Bromide (223) - via neb and O2 8L/min
>= 6yo: 500mcg, repeat once, max 2 doses
<6yo: 250mcg, repeat once, max 2 doses

Hydrocortisone (238) - 100mg vial reconstituted with 2mL normal saline 0.9% (50mg:1mL); IM/IV
>= 16yo: 100mg, no repeat, max 1 dose
6-<16yo: 4mg/kg, max bolus 100mg, no repeat, max 1 dose
<6yo (S/LT only): 4mg/kg, max bolus 100mg, no repeat, max 1 dose

Adrenaline (201) - IM into lateral aspect of thigh or IV slow injection
>=16yo:
500mcg 1:1,000 IM, repeat every 5 min whilst indicated, no max
100mcg 1:10,000 slow IV injection if unresponsive to IM injection, repeat every minute whilst indicated, no max
<16yo:
10mcg/kid 1:1,000 IM, repeat every 5 min whilst indicated, no max
10mcg/kg 1:10,000, max bolus 100mcg, slow IV injection if unresponsive to IM injection, repeat every 5 min whilst indicated, no max.

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Medical/Surgical Protocols 2016 (11 decks)

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