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Year 3: Respiratory > Respiratory: Acute Asthma > Flashcards

Respiratory: Acute Asthma Flashcards

1
Q

What are the presenting features of an acute exacerbation of asthma? [5]

A
  • Progressively shortness of breath
  • Use of accessory muscles
  • Raised respiratory rate (tachypnoea)
  • Symmetrical expiratory wheeze on auscultation
  • The chest can sound “tight” on auscultation, with reduced air entry throughout
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2
Q

What are the different classifications of acute asthma? [5]

A
  • Brittle
  • Moderate
  • Acute severe
  • Life-threatening
  • Near-fatal
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3
Q

Describe what is meant by brittle asthma [2]

A

*Type 1:
- wide PEF variability (>40% diurnal variation for >50% of the time over a period >150 days) despite intense
therapy

*Type 2:
- sudden severe attacks on a background of apparentlywell-controlled asthma

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4
Q

Describe what is meant by moderate exacerbation of asthma [6]

A
  • Increasing symptoms
  • Speech normal
  • PEF >50-75% best or predicted
  • No features of acute severe asthma
  • RR < 25 / min
  • Pulse < 110 bpm
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5
Q

Describe what is meant by an acute severe exacerbation of asthma [4]

A

Any one of:
* PEF 33-50% best or predicted
* respiratory rate >25/min
* HR > 110bpm
* inability to complete sentences in one breath

Admit – if persisting symptoms

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6
Q

Describe what is meant by a life threatening exacerbation of asthma [10]

A
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7
Q

What is a pneumonic for life-threatening exacerbation of asthma?

A

33-92 CHEST:

  • PEF < 33%
  • sats < 92%
  • Cyanosis or confusion
  • Hypotension
  • Exhaustion
  • Silent chest
  • Tachy or bradychardia
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8
Q

Describe what is meant by a near fatal exacerbation of asthma [1]

A

Raised PaCO₂ (>6kPa) and/or need for mechanical ventilation.

It typically correlates with an FEV1 around 20% of predicted or less.

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9
Q

Which levels of acute asthma should you admit? [2]

A

Life threatening attack
Severe attack that is persisting after initial treatment

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10
Q

What PEF can you discharge if other needs are met? [1]

State some reasons why might not be discharged [5]

A

> 75% after 1hr

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11
Q

D

Describe the treament algorithm / management plan for acute asthma

A

ABC
Oxygen:
- High flow
- Aim sats >92

IV fluids

Reassess
- Every 15mins with PEFR

Therapys:
Oxygen
Salbutamol
Hydrocortisone/Prednisolone
Ipratropium bromide
Theophylline
! Magnesium sulphate

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12
Q

What dose salbutamol would you give? [1]
How is it delivered? [1]
How often? [1]

A

2.5-5mg every 10 minutes
Nebulised with oxygen

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13
Q

Side effects of salbutamol tx for acute asthma? [3]

A
  • Tremor
  • Arrhythmias
  • Hypokalaemia (monitor ECG)
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14
Q

Which ICS would you give in acute asthma? [2]
What dose? [2]
How is it delivered? [1]
How often? [1]

A

Hydrocortisone
-IV 100-200mg QDS

prednisolone
- PO 40mg OD

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15
Q

Acute asthma

What dose ipratropium bromide would you give? [1]
What is the MoA? [1]
How is it delivered? [1]
How often? [1]

A

Ipratropium bromide
- Nebulised with oxygen
- Muscarinic antagonist: Bronchodilator
- 500 micrograms every 4-6 hours

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16
Q

Acute asthma

What dose Magnesium sulphate would you give? [1]
What is the MoA? [1]
How is it delivered? [1]
How often? [1]

A

Magnesium sulphate
1.2 – 2 grams over 20 minutes IV
Bronchodilator

17
Q

What dose theophylline would you give? [1]
What is the MoA? [1]
How is it delivered? [1]
How often? [1]

A

Theophylline
Inhibit phosphodiesterase and increase cAMP – smooth muscle dilation
Life-threatening
Senior guidance

18
Q

What is the treatment plan for Mild asthma attacks? [5]

A
  • Inhaled beta-2 agonists (e.g., salbutamol) via a spacer
  • Quadrupled dose of their inhaled corticosteroid (for up to 2 weeks)
  • Oral steroids (prednisolone) if the higher ICS is inadequate
  • Antibiotics only if there is convincing evidence of bacterial infection
  • Follow-up within 48 hours
19
Q

What is the treatment plan for moderate asthma attacks? [3]

A
  • Consider hospital admission
  • Nebulised beta-2 agonists (e.g., salbutamol)
  • Steroids (e.g., oral prednisolone or IV hydrocortisone)
20
Q

acute asthma

What is the treatment plan for severe asthma attacks? [3]

A
  • Hospital admission
  • Oxygen to maintain sats 94-98%
  • Steroids (e.g., oral prednisolone or IV hydrocortisone)
  • Nebulised ipratropium bromide
  • IV magnesium sulphate
  • IV salbutamol
  • IV aminophylline

OSHIT

21
Q

acute asthma

Life-threatening exacerbations may additionally be treated with? [2]

A

Admission to HDU or ICU
Intubation and ventilation

22
Q

Why is it important to intubate early in life threatening asthma? [1]

A

It’s very difficult to intubate with severe bronchoconstriction.

23
Q

What indications would be for intubation in life-threatening asthma? [5]

A

There are few indications apart from coma and arrest.

However, findings such as severe fatigue, cardiovascular compromise and pneumothorax may be useful in decision making about mechanical ventilation

24
Q

Describe side effects of salbutamol tx [3]

A

Serum potassium needs monitoring with salbutamol treatment, which causes potassium to be absorbed from the blood into the cells, resulting in hypokalaemia

  • tachycardia (fast heart rate)
  • lactic acidosis.
25
Q

What might an ECG reveal when treating acute asthma? [1]

A

Sinus tachycardia (from Mg2+ and K)

26
Q

What is the follow up plan when discharing acute asthma exacerbations? [3]

A

o Follow up within 48 hrs
o < 30 days post discharge by GP/nurse specialist
o under specialist supervision indefinitely for near-fatal asthma and
at least 1 yeat for severe asthma attack

27
Q

When a patient is presenting at hospital with acute asthma, how do you decide what ICS might be prescribed? [2]

A

All patients with acute asthma should receive oral prednisolone

Only if vomiting: give IV hydrocortisone

28
Q

What is a pneumonic for discharge criteria for acute asthma? [3]

A
29
Q

A 35-year-old lady with a history of asthma is brought to the Emergency Department with an acute asthma attack. She has previously been admitted to the intensive therapy unit (ITU) with the same problem. Treatment is commenced with high-flow oxygen and regular nebulisers.

Which of the following is a feature of life-threatening asthma?

Normal PaCO2
Peak expiratory flow rate < 50% of predicted or best
Pulse rate 105 bpm
Respiratory alkalosis
Unable to complete full sentences

A

Normal PaCO2

30
Q

What indicates life-threatening asthma? [1]
Why? [1]

A

A normal PaCO2 in an acute asthma attack indicates exhaustion and should, therefore, be classified as life-threatening

31
Q

Explain why in acute asthma, a pH of < 7.35 is particularly alarming [1]

A

A pH less than 7.35 likely represents carbon dioxide retention in a tiring patient and is an ominous sign in acute asthma.

Year 3: Respiratory (42 decks)

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