Shortness of Breath with or without a History of Asthma

Question 1

Clinical Severity Prompts

Answer 1

See Clinical manifestation of acute asthma table:

1. Mild

2. Moderate

3. Severe (life-threatening)

Question 2

History Prompts

Answer 2

Onset

Associated symptoms

Relevant past history

Medication history

Trigger factors

Past presentation/s admission/s (ED/ICU/intubation

Allergies

Question 3

Airway - Assessment

Answer 3

Assess patency

Assess for signs of pre-arrest or asthma associated with anaphylaxis

• decreasing LOC
• increasing cyanosis of lips/mouth
• bradycardia

Question 4

Airway - Intervention

Answer 4

Maintain airway patency

If the patient is pre-arrest or asthma associated with anaphylaxis,

⇒ give IM Adrenaline 0.5mg (one dose only)

Question 5

Breathing - Assessment

Answer 5

Respiratory rate & effort

SpO2

(Auscultation)

Speech

Use of accessory muscles

Sternal retraction

Spirometry/PEFR (moderate & mild asthma)

Assess as: Severe ⇔ Moderate ⇔ Mild

Question 6

Breathing - Intervention

General

Answer 6

Assisst ventilation as required

Apply O2 to maintain SpO2 > 95%

Question 7

Breathing - Intervention

Severe asthma

Answer 7

8-12 puffs Salbutamol 100mcg MDI + spacer every 15-30 minutes

4 puffs Ipratropium Bromide 20mcg MDI + spacer stat

**if patient cannot inhale adequately ⇒ give Salbutamol 5mg nebule & Ipratropium Bromide 500mcg nebule

Question 8

Breathing Intervention

Moderate asthma

Answer 8

8-12 puffs Salbutamol 100mcg MDI + spacer every 1-4 hours

Question 9

Breathing intervention

Mild asthma

Answer 9

8-12 puffs Salbutamol 100mcg MDI + spacer stat

Question 10

Circulation - Assessment

Answer 10

Skin temperature - touch

Pulse rate/rhythm

Capillary refill

Blood pressure

Cardiac monitor

Electrocardiography

Question 11

Circulation - Intervention

Answer 11

IV cannulation for moderate and severe asthma

Monitor vital signs frequently

12-lead ECG

Question 12

Disability - Assessment

Answer 12

AVPU / GCS

Question 13

Disabillity - Intervention

Answer 13

Monitor LOC frequently

Question 14

Measure + test

Answer 14

Temperature

Spirometry

Question 15

Specific treatment

for continuing respiratory distress…?

Answer 15

For moderate & severe asthma give IV Hydrocortisone 200mg

or (if IV access unavailable)

oral Prednisalone 50mg