Respiratory (medium) Flashcards
what are the different Peak flow percentages for moderate, severe and life-threatening asthma attacks
moderate: 50-75%
severe: 33-50%
life threatening: <33%
what are the oxygen saturations for someone having a moderate acute asthma attack and life threatening asthma attack
moderate: >92%
life threatening: <92%
what is the likely respiratory rate for a child 1-5 having moderate asthma attack and anyone over the age of 5
child 1-5: <40
5+: <30
what is the treatment management for moderate acute asthma attack?
can be treated in primary care or home
high dose SABA (salbutamol usually)
up to 10 puffs at once via PMI or spacer
if inadequate response -> hospital
PLUS
oral prednisolone for 5 days OR
IV hydrocortisone/ IM methylprednisolone if oral pred not appropriate
hypoxaemic patients should be given supplemental oxygen with target spO2 94-98%
what is the likely respiratory rate and HR for someone having an asthma attack in:
adults
children over 5
children 1-5
adults: >25, HR >125
5+: >30, HR>125
1-5:>40, HR>140
Treatment of someone having a severe asthma attack
hospital immediately
high dose SABA (Salbutamol) via oxygen driven nebuliser
can give with or without nebulised ipratropium (SAMA)
PLUS
oral prednisolone for 5 days OR
IV hydrocortisone/ IM methylprednisolone if oral pred not appropriate
hypoxaemic patients should be given supplemental oxygen with target spO2 94-98%
symptoms of life threatening asthma attack
altered consciousness hypotension cyanosis silent chest exhaustion
management of life threatening asthma attack
high dose SABA via oxygen nebuliser
+/- nebulised ipratropium
IV aminophylline
PLUS
oral prednisolone for 5 days OR
IV hydrocortisone/ IM methylprednisolone if oral pred not appropriate
hypoxaemic patients should be given supplemental oxygen with target spO2 94-98%
treatment for children over 2 having an asthma attack
1st line: SABA (Salbutamol)
if moderate: via PMI or space -> A+E if not controlled after 10 puffs
if sever: via nebulised oxygen-driven nebuliser
PLUS
oral prednisolone for 3 days
poor response to SABA -> give nebulised ipratropium
poor response to 1st line: IV magnesium sulphate
treatment for children under 2 having an asthma attack
always treated in hospital
immediate oxygen + trial a SABA
If needed add: nebulised ipratropium
Step 1 of management of long term Asthma
reliever: SABA (salbutamol) PRN
When should step 2 be initiated for long term management of asthma
using SABA >3x a week
experience symptoms >3x a week
waking up at night >1 x a week
using >1 inhaler per month
what is step 2 in asthma management
what is the difference in children under 5
reliever (SABA) + low dose ICS (preventor)
for children under 5 trial the ICS for 8 weeks - if not effective try montelukast
what is the treatment management step 3 in asthma management
SABA + ICS + LABA (BTS/SIGN)
- can be given as fixed dose LABA or MART (maintenance and reliever)
SABA + ICS + LTRA (NICE)
-this is used for children <5 -> if LTRA not effective can be stopped and refer to specialist
LABA only for >12
what is the maintenance treatment management for Step 4 for asthma
add LABA if not already added (i.e. if gone down NICE route)
- this can be with out with LTRA
- can convert to MART at this stage (if gone down BTS/ sign route)
in children replace LTRA with LABA
Can be given as MART
step 5 of asthma management
under a specialist: increase to high strength ICS or initiate the following:
- theophylline
- monoclonal antibody
- oral corticosteroids (e.g., prednisolone)
- tiotropium (over 12 only) (LAMA)
how is the management of asthma tapered down
reviewed every three months
asthma should be well controlled for 3 months
maintain them on the lowest possible effective ICS dose
Reduce dose by 25-50% if appropriate