Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - Paediatrics > Respiratory - Acute and Chronic Asthma > Flashcards

Respiratory - Acute and Chronic Asthma Flashcards

1
Q

How does an acute exacerbation of asthma present?

A

Progressively worsening SOB
Signs of respiratory distress
Tachypnoea
Expiratory wheeze throughout chest
Chest sounds tight on auscultation with reduced air entry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What can a silent chest be a sign of?

A

Airways so tight not possible for child to move enough air to create a wheeze

Can also be associated with reduced respiratory effort due to fatigue

Life-threatening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different signs in moderate, severe and life threatening asthma exacerbations?

A

Moderate
Peak flow > 50% predicted
Normal speech

Severe
Peak flow < 50% predicted
Saturations < 92%
Unable to complete sentences in one breath
Respriatory distress signs

Respiratory rate
> 40 in 1-5 year olds
> 30 in > 5 year olds

Heart rate
> 140 in 1-5 year olds
> 125 in > 5 years

Life threatening
Peak flow < 33% predicted
Saturations < 92%
Exhausation and poor respiratory effort
Hypotension
Silent chest
Cyanosis
Altered conscioussness/ confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is used to manage acute viral induced wheeze or asthma?

A

Supplementary oxygen (if under 94% sats)
Bronchodilators
Steroids- to reduce airway inflammation
Antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What steroids can be used to reduce airway inflammation?

A

Prednisolone (oral)
Hydrocortisone (IV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How are bronchodilators stepped us as needed?

A
  • Inhaled or nebulised salbutamol (B2)
  • Inhaled or nebulised ipratropium bromide (anti-muscarinic)
  • IV magnesium sulphate
  • IV aminophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are mild cases of acute asthma exacerbations managed?

A

Outpatient with regular salbutamol inhalers via a spacer

4-6 puffs every 4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the stepwise approach for treating moderate to severe cases of asthma exacerbations?

A
  1. Salbutamol inhalers via spacer, 10 puffs every 2 hours
  2. Nebulisers with salbutamol / ipratropium bromide
  3. Oral prednisolone
  4. IV hydrocortisone
  5. IV magnesium sulphate
  6. IV salbuatmol
  7. IV aminophylline

Call anaesthetist and ITU, may need intubation and ventilation if no control by this point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the signs of respiratory distress?

A

Tracheal tug
Subcostal recessions
Hypoxia
Tachypnoea
Wheeze on auscultation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What needs to be monitored when giving high doses of salbutamol?

A

Serum potassium

As potassium is absorbed from the blood into cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What side effects can acute salbutamol use cause?

A

Tachycardia
Tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What step down regime of inhaled salbutamol is used?

A

10 puffs 2 hours
10 puffs 4 hourly
6 puffs 4 hourly
4 puffs 6 hourly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When can discharge for acute asthma exacerbations be considered?

A

When the child is well on 6 puffs 4 hourly of salbutamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What other steps should be considered when discharging after an asthma exacerbation?

A
  • Finish the course of steroids if started
  • Provide safety-net information about when to return to hospital or seek help
  • Provide individualised asthma action plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What presentation suggests a diagnosis of asthma?

A
  • Episodic symptoms with intermittent exacerbations
  • Diurnal variability, worse at night and early morning
  • Dry cough with wheeze and SOB
  • Typical triggers
  • History of atopic conditions
  • Family history of atopic conditions
  • Bilateral widespread polyphonic wheeze
  • Symptoms improve with bronchodilators
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What presentation indicates a diagnosis other than asthma?

A
  • Wheeze only related to coughs and colds
  • Isolated or productive cough
  • Normal investigations
  • No response to treatment
  • Unilateral wheeze suggesting focal lesion, inhaled foreign body or infection
17
Q

What are the typical triggers of asthma?

A

Dust
Animals
Cold air
Exercise
Smoke
Food allergens

18
Q

How is low to high probability asthma diagnosed?

A

Based on history and examination

Children not diagnosed until 2-3 years old

When low chance of asthma and child symptomatic, refer to specialist for diagnosis

With high chance, trial of treatment implemented and if symptoms improve diagnosis can be made

19
Q

What investigations are used for immediate probability asthma diagnosed?

A

Spirometry with reversibility testing (children over 5)
Direct bronchial challenge test with histamine or methacholine
Fractional exhaled nitric oxide FeNO
Peak flow variability, keep diary for 2 to 4 weeks

20
Q

What are the principles of using the stepwise ladder?

A

Start at the most appropriate step for severity of symptoms
Review at regular intervals
Step up or down ladder based on symptoms
Aim for no symptoms or exacerbations on lowest dose
Always check inhaler technique and adherence at each review

21
Q

What medical therapy is used in under 5s?

A
  1. Start a short-acting beta-2 agonist as needed (salbutamol)
  2. Add low dose corticosteroid inhaler or LTR antagonist (oral montelukast)
  3. Add the other option from step 2
  4. Specialist referral
22
Q

What medical therapy is used in 5-12 year olds?

A
  1. Start short-acting beta-2 agonist as needed
  2. Add regular low dose corticosteroid inhaler
  3. Add long-acting beta-2 agonist e.g. salmeterol, continue salmeterol if patient has a good response
  4. Titrate up corticosteroid to medium dose, consider adding LRTA or oral theophylline
  5. Increase dose of ICS to high dose
  6. Referral to specialist, may need daily oral steroids
23
Q

What medical therapy is used for over 12s?

A
  1. Start a SABA
  2. Add low dose ICS
  3. Add a LABA
  4. Titrate up corticosteroid inhaler to medium dose, consider oral LTRA, oral theophylline or inhaled LAMA
  5. Titrate inhaled corticosteroid to high dose, add additional treatments
  6. Add oral steroids at lowest dose, specialist
24
Q

Can inhaled steroids affect growth?

A

Can slightly reduce growth and cause a small reduce in final adult height up to 1cm when used long-term

Dose-dependent

Medications act to prevent poorly controlled asthma and attacks that could lead to higher doses of steroids

Poorly controlled asthma can lead to more of an impact on growth

Regular asthma reviews to ensure they are growing well and on minimal dose

25
Q

Why is inhaler technique so important?

A

Better the technique, more medication reaches the lungs

Poor technique causes medication in the mouth or back of throat, reducing effectiveness and leading to oral thrush

26
Q

What should be used to increase effectiveness of inhalers?

A

Spacer device

27
Q

How often should spacers be cleaned?

A

Once a month

Avoid scrubbing and allow them to air dry to avoid creating static

Static can interact with mist and prevent the medication being inhaled

28
Q

What is the typical salbutamol inhaler called?

A

Metered dosed inhaler (MDI)

Year 4 - Paediatrics (150 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions