RRAPID: Acute Severe Asthma

Question 1

What are the triad of symptoms?

Answer 1

Wheeze/Chest tightness
SOB
Cough

Question 2

Features of acute severe asthma? (4)

Answer 2

Any one of:
Inability to complete sentences in one breath
RR >25 per min
HR > 110
PEFR 33 - 50% of predicted

Question 3

Features of life threatening asthma? (7)

Answer 3

Any one of:
Altered conscious level
Exhaustion/poor respiratory effort
Silent chest
PEFR <33% of predicted
PaO2 <8kPA or O2 sats <92% on air
Normal PaCO2 (4.6 - 6.0 kPA)
Arrhythmia

Question 4

Near fatal features?

Answer 4

Raised PaCO2 / or requiring mechanical ventilation with raised pressures

Question 5

Response (Airway)?

Answer 5

Sit patient up

Give O2 15L/min via reservoir mask

Question 6

Response (Breathing)?

Answer 6

PEFR
ABG
CXR (to exclude infection + pneumothorax)

Question 7

Response (Circulation) ?

Answer 7

IV access (bloods: FBC, U&E’s, glucose) + consider CRP, blood & sputum cultures if suspected sepsis

Question 8

Medication Mx? O SHIT ME

Answer 8

Salbutamol 5mg NEB with O2 (repeat 15-20 mins intervals)

Ipratropium bromide 500 mcg NEB with O2 (4-6 hourly)

Hydrocortisone 200 mg IV (stat) or prednisolone 40 mg PO (QDS for at least 5 days)

Magnesium sulphate 1.2 - 2g IV over 20 mins

Question 9

What Mx if life threatening features?

Answer 9

Contact ICU
Back to back salbutamol NEBS
Consider aminophylline infusion (seek senior medical advise)