Respiratory

Question 1

Asthma considerations for P1/time critical

Answer 1

prior ICU admit
prior intubation
>3 ED visits this year
>2 hosp admits
>1 bronchodilator used in last month
puffer use > every 4 hours
chronic steroid use
progressive symptoms despite aggressive treatment
unable to speak in sentences

Question 2

Medication doses for asthma

Answer 2

A- Salbutamol- 4-12 puffs rpt 20 minutes or sooner
P- 2-6 puffs, rpt 20 minutes or sooner
1puff/4 breaths

Neb- 1-2 nebs (5-10mg in 2.5-5ml). continuous in life threatening

Atrovent
A- Neb- 500mcg (2x 250mcg vials), rpt 20 minutely with max 3 doses.
P- Neb 250 mcg

A- MDI- 8 puffs (160mcg) 1 breath per puff every 20 mins with max dose 3.
P-MDI 4 puffs (80mcg)

Adrenaline-
A- 0.5 mg in 0.5 ml IM 5 minutely
P- 10 mcg/kg max dose 0.5

Question 3

Asthma vent rate

Answer 3

4-6 breaths per minute

Question 4

Severe asthma signs

Answer 4

use of accessory muscle, intercostal muscles, tracheal tug, subcostal recession
unable to complete sentences in one breath
obvious resp distress
o2 90-94%
audible wheeze

Question 5

Life threatening asthma signs

Answer 5

reduced consciousness/ collapse
exhaustion
cyanosis
o2 <90%
poor resp effort/ soft or absent breath sounds

Question 6

COPD management

Answer 6

Salbutamol- 4-12 puffs rpt 20 minutes or sooner

Neb- 1-2 nebs (5-10mg in 2.5-5ml). continuous in life threatening

Atrovent
Neb- 500mcg (2x 250mcg vials), rpt 20 minutely with max 3 doses.

MDI- 8 puffs (160mcg) 1 breath per puff every 20 mins with max dose 3.

o2 to target 88-92%

Question 7

Salbutamol uses

Answer 7

Bronchospasm and resp distress with associated wheeze

acute bronchial asthma
bronchitis
smoke inhalation
severe allergic reaction/ anaphylaxis
APO- non cardiogenic
salt water aspiration
COPDA

Question 8

Atrovent use

Answer 8

A- Severe life threatening asthma or COPD

P- severe to life threat asthma

Question 9

Croup treatment

Answer 9

O2
mild to mod- prednisolone 1mg/kg max dose 25mg single dose
severe- Neb adrenaline 5mg undiluted rpt 15 minutely if required followed by pred

Question 10

severe croup signs

Answer 10

persistent stridor at rest
pallor and mottling
severe sternal recession/ tracheal tug
drooling
irritable/ lethargic

Question 11

moderate croup

Answer 11

barking cough
audible stridor at rest
mild sternal recession / tracheal tug
may be irritable

Question 12

Choking management

Answer 12

5 back blows
5 chest thrusts
repeat until unconscious

commence CPR
attempt to remove with laryngoscope/ magill
surgical crico

Question 13

COPD presentation

Answer 13

Resp distress
sputum production
cough
hx of exposure to risk factors
Chronic bronchitis, emphysema, bronchiectasis