S8C72 - Acute Asthma in Adults

Question 1

Asthma defn

Answer 1

-chronic inflammatory d/o that is reversible

Question 2

Asthma: pathophys

Answer 2

• decr airway diameter due to smooth muscle contraction, vascular congestion, bronchial wall edema and thick secretions
• IgE dependent mediators: histamine, leukotrienes, tryptase, prostaglandins

Question 3

Asthma: presentation

Answer 3

• triad: dyspnea, wheezing, cough
• mild: dypsnea with activity, PEF >70% predicted or personal best
• moderate: dyspnea interferes with regular activity, PEF 40-70% personal best/predicted
• severe: dyspnea at rest, interfers with conversation, PEF

Question 4

Asthma: tx

Answer 4

Beta Adrenergic Agonist: ventolin

• beta 2 agonists promote bronchodilation, vasodilation, uterine relaxation, skeletal muscle tremor
• stimulate adenly cyclase which makes cAMP from ATP and cAMP decreases intracellular calcium so less contraction
• also promote mucocillary clearance
• SE: tremor, nervous, anxiety, insomnia, h/a, hyperglycemia, palpitations, tachycardia, hypertension, (lactic acidosis???)

Anticholinergics

• affect large central airways
• blocks bronchoconstriction
• decreases hospitalization
• atrovent 0.5mg (2ml) q20mins x3 doses
• atrovent MDI 18mcg/puff - 8 puffs q20mins as needed up to 3h
• SE: dry mouth, thirst, tachy, restless, confused, ileus, blurred vision, difficulty with micturition

Corticosteroids

• ? increase beta-adrenergic responsiveness and reuce inflm
• onset is 4-8h
• reduce the need for hospitalization
• prednisone 40-60mg PO, methylprednisolone 1mg/kg IV

INhaled Steroids

• budesonide 180-600mcg/d
• fluticasone 88-264mcg/d

Magnesium
-for acute very sever asthma (FEV1

Question 5

Asthma: NPPV

Answer 5

• do not give if suspect pneumothorax

- use if signs of respiratory failure

Question 6

Asthma: intubation

Answer 6

• intubate if progressive hypercarbia and acidosis, pt exhausted/vofused, impending repiratory arrest
• does not relieve airflow obstruction, just gives the pt a bit of rest
• complications of intubation are high: barotrauma, high peak pressures, increased resistance
• ensure rapid inspiratory flow rate with prolonged expiratory phase

Question 7

Asthma: disposition

Answer 7

• pt with good response to treatment with resolution and PEF or FEV1 >70% predicted can be d/c home
• if FEV1 or PEF remains at

Question 8

Asthma: pregnancy

Answer 8

-pregnancy pts have higher PaO2 and lower PaCO2 than normal therefore a PaCO2 >35 represents respiratory failure and a PaO2 of