Paeds: Management of acute Asthma HW

Question 1

Moderate asthma exacerbations

Answer 1

• Worsening of symptoms
• PEFR 50-75% of predicte or best
• Speech normal
• RR >30 bpm
• Pulse >120bpm

Question 2

Severe asthma attack

Answer 2

• Can’t complete sentences/too breathless to speak or feed
• RR: Adults >25 bpm. Children >30 bpm. Under 5s >50bpm
• Pulse: Adults >110 bpm. Children 120 bpm. Under 5’s 130 bpm
• PEFR 33-50% predicted or best

Question 3

Life-threatening asthma attack

Answer 3

• PEFR

Question 4

Near fatal asthma attack

Answer 4

Increase in PaCo2 and/or requiring mechanical ventilation with raised inflation pressure

Question 5

Management of acute asthma

Answer 5

• Oxygen -high flow 40-60%
• Nebulised salbutamol ( + ipratropium bromide if acute severe of life-threatening attack).
• systemic corticosteroids - Oral prednisolone or iv hydrocortisone (if unable to swallow)
• IV fluids - Also K+ supplements may be neccessary as repeat salbutamol reduced serum K+
• Aminophylline or iv magnesium if 1. life threatening attack or 2. Poor response to Nebulised bronchodilators

Question 6

Indications for assisted ventilation in acute severe asthma:

Answer 6

• Coma
• Respiratory arrest
• Deterioration of ABG (reduced PaO2 ± raised PaCO2 ± ph reduced)
• Exhaustion, confusion, drowsiness

Question 7

Discharge

Answer 7

• Should be stable on discharge meds (nebulised therapy discontinued for 24 hours)
• PEF 75% of predicted or best
• Appointment with GP/asthma nurse in 2 working days and follow-up at specialist hospital clinic in a month.