Treatment Summaries - acute asthma Flashcards
what parameters are reduced marking an acute exacerbation of asthma?
peak expiratroy flow rate
FEV1
T/F: most ashtma attacks severe enough to require hospitalisation develop rapidly over 1 hour
false - they develop slowly over a period of 6 hours
what is a common trigger for intermittent wheezing attachs in children?
viral infections
low birth weight and/or prematurity
what 3 factors describe moderate acute asthma?
- increasing symtpoms
- peak flow >50 - 75% best or predicted
- no features of acute severe asthma
give 4 features of acute severe asthma, how many features must a person have to have severe acute asthma?
- peak flow 33 - 50% best or predicted
- resp rate > 25/min
- heart rate >110/min
- inability to complete scentences in one breath
just need one feature
Name 5 features of life-treatening acute asthma
- peak flow <33% best or predicted
- arterial oxygen saturation (SpO2) <92%
- partial arterial pressure of oxygen <8kPa
- silent chest
- cyanosis
- altered consiousness
- silent chest
- normal partial arterial pressure of CO2 (paCO2) (4.6 - 6.0kPa)
whats the sign of near-fatal acute asthma?
raised PaCO2 and/or need for mechanical ventilation with raised inflation pressures
Give 5 signs of moderate acute asthma in children and how do these change in severe acute asthma?
- able to talk in scentences = cant complete scentences
- arterial oxygen saturation (SpO2) >92% = <92%
- peak flow >50% best or predicited = 33 - 50% best or predicted
- HR <140 in 1 - 5yrs, HR <125 in children over 5 = >140/min in 1 - 5yrs, >125/min in 5yrs+
- RR <40/min in 1 - 5yrs, <30/min in 5yrs+ = >40/min in 1 - 5 yrs and >30/min in 5yrs+
when would a hospital referral be warranted in adults with moderate acute asthma?
poor response to treatment, social circumstances or concomitat disease
what should be given to all hypoxaemic pateints with severe acute asthma?
what arterial oxygen saturation do we aim for?
Do you delay is pulse oximetry is unavailable?
give supplementary oxygen
94 - 98%
how would you deliver salbutamol to someone with mild to moderate actute asthma compared to severe?
mild to moderate - give as pressurised metered dose inhaler, severe - give via oxygen driven nebuliser
what should all patients be prescribed in acute asthma in combination with inhaled corticosteorids
oral prednisolone
what therapy can be given in combination with a nebulised beta2 agonist in patients with severe/life threatening asthma or have poor response to SABAs?
what class is it?
ipratropium bromide
antimuscarinic
when could aminophylline be considered?
in patients with near-fatal or life-threatening acture asthma but in acute asthma attacks its not likely to give additional bronchodilation compared to standard therapy
when could magnesium sulfate be considered?
in patients with severe acute asthma with peak flow <50% best or predicited
what setting should all acute asthma attacks under 2yrs be treated?
what about under 1yrs
hospital
under 1 - under direct guidance of respiratory paediatrictian
outline the management for moderate and severe acute ashtma attacks in under 2yrs (3 points)
- immediate treatment with oxygen via a tight fitting face mask or nasal prongs to achieve SpO2 94 - 98%
- trial inhaled SABA -
- if response poor combine nebulised ipratropium bromide to each SABA dose
when and how long can prednisolone be given for children under 2?
in severe asthma attacks,
use daily for up to 3 days
when should children over 2 be reffered to hospital for acute asthma attacks?
what should be given on arrival to hospital - what targets are you aiming for?
when severe or life-threatening
or fails to respond to treatment
give high flow oxygen via tight fitted mask or nasal cannula to achieve SpO2 94 - 98%
how is the management in mild - moderate different in children to adults
SABA given via pMDI with spacer in children
when should parents/careres of children with acute asthma at home seek urgent medical attention if symptoms not releived after how many puffs of salbuamol?
10 puffs via a spacer
when should urgent medical attention be sought for children (return of symptoms)
what can be done whilst waiting for help?
if symptoms return in 3 - 4 hours
give an additional 10 puffs of salbutamol via spacer
when treating children over 2 with prednisolone…
- what course should be long enough?
- what should you do in children who vomit?
- should you continue inhaled corticosteroids?
- 3 days should be enough but course should be tailored for number of days needed for recovery
- repeat dose or consider IV route
- good practice to continue inhaled corticosteroids, not to be used as replacement for the oral corticosteroid
when can ipratroptium be given to children over2?
poor response to SABA to provide greater bronchodilation
when can ipratroptium be given to children over2?
poor response to SABA to provide greater bronchodilation
when can you give magnesium sulfate (unlicensed) to children over 2?
can add to SABA/ipratropium in the first hour in children with a short duration of severe acute asthma symptoms presenting with oxygen sat <92%
what is given and what needs to monitored in children over 2 in a severe attack not responding to first line treatments?
- single IV bolous salbutamol
- continuous ECG and electrolyte monitoring
when can you consdier aminophylline in children over 2 ?
in severe or life treatening acute asthma unpresonsive to maximal doses of bronchodilators and corticosteorids
