Respiratory Emergencies: Life-threatening Asthma, Flail Chest Flashcards
What are the classic signs and symptoms of life-threatening asthma?
33 92 A CHEST mnemonic: If a patient has one of the following it is life-threatening asthma
PEFR is less than 33% of personal best
Oxygen saturation is less than 92%
C: Cyanosis and confusion
H: Hypotension
E: Exhaustion
S: Silent chest
T: Threatening PEF
How do you manage life-threatening asthma?
OSHITME mnemonic
O: High-flow oxygen
S: Nebulised salbutamol, ideally oxygen-driven
H: Hydrocortisone
I: Ipratropium bromide
T: Theophylline
M: Magnesium sulfate
E: Escalate care
In life-threatening asthma management, how is high-flow oxygen administered and what should the result be?
High-flow oxygen through tight fitting mask or nasal cannula
Keep oxygen saturation between 94-98%
In life-threatening asthma management, what dose of nebulised salbutamol is given, and in what kind of nebuliser?
5mg for adults, 2.5mg for children
Ideally oxygen-driven nebuliser, otherwise use air-driven nebuliser
In life-threatening asthma, what dose and route is used to administer hydrocortisone?
100mg IV hydrocortisone
In life-threatening asthma, what is the second-line steroid that should be used if hydrocortisone can’t be used?
Prednisolone 40-50mg PO
In life-threatening asthma, what is the mechanism of ipratropium bromide, and give 2 reasons why it is used?
Anticholinergic drug used to control symptoms of bronchospasm
Added to nebulised salbutamol to increase initial response and has minimal side effects
In life-threatening asthma management, what dose and route is used to administer ipratropium bromide?
500 micrograms NEB for adults, 250 micrograms NEB children aged 2-12
In life-threatening asthma management, what dose and route is used to give theophylline?
1g aminophylline infusion IV
In life-threatening asthma management, what dose and route is used to give magnesium sulfate, and for how long?
Stat dose 2g magnesium sulfate IV
Given over 20 minutes
What is the role of magnesium sulfate in treating life-threatening asthma?
Produces rapid and marked bronchodilation
What is flail chest?
Life-threatening condition where segment of rib cage breaks due to trauma and detaches from chest wall
What are the 4 classic signs of flail chest?
Paradoxical movement of chest wall where broken segment draws in when patient inhales and chest expands, and segment moves out when patient exhales and chest shrinks
Dyspnea
Chest pain
Bruising in affected area
