Week 5 Flashcards by caitlin gill

what is the treatment for severe asthma for an adult as per AV CPGs?

Salbutamol 10mg in 5ml nebulised (repeat 5mg in 2.5ml every 5 minutes)
Iprotropium bromide 500mcg in 2mL nebulised

Dexamethasone 8mg IV/Oral

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What is the presentation of dexamethasone?

8mg in 2ML

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What is the presentation of ipratropium bromide?

250mcg in 1mL

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What are the contraindications for adrenaline?

Hypovolaemic shock without adequate fluid replacement

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What is the response of histamine?

histamine causes blood vessels to dilate and become leaky, which promotes oedema, stimulates secretion of mucus and causes smooth muscle to contract

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What are the permanent airway changes due to asthma?

Airway remodelling by the body to repair the tissue.

Leads to a thickening of the airway wall even when relaxed.

Goblet cell hyperplasia occurs worsening the hypersecretion of mucous

Collagen deposits in epithelial basement membrane leading to loss of lung function

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What is the presentation of adrenaline?

1mg in 1mL

1mg in 10mL

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What is the last branch of the conducting airway?

Terminal bronchioles - where gas exchange occurs

More than 32k terminal bronchioles

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What is the patterns of asthma?

Perennial and or seasonal
Continual or episodic
Onset
Duration
Frequency
Aggravating factors

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What are side effects of salbutamol?

sinus tachy
muscle tremor

others:

anxiety
headache
dry mouth
palpitation
muscle cramps
flushing

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what are important history notes to take for an asthmatic patient?

Do they have asthma
Previous hospital admissions
ED visits in the last year
ICU visits
Requirement of intubation
The usual response to management
use of steroids in last 6 months
how long has exacerbation been?
how does it compare to other attacks?

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What is the presentation of salbutamol?

5mg in 2.5mL

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What are some triger factors for Asthma?

Pollen
Exercise
Allergens
Resp infections
Drugs
Foods
Gastro-oesophageal reflux disease
Smoking
Air pollutants
Occupational factors
Temperature change

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what is the treatment for severe asthma for a paediatric as per AV CPGs?

Salbutamol nebulised:
Small child (2-4 years) = 2.5mg in 1.25ml
Medium child (5-11 years) = 2.5-5mg in 1.25 - 2.5ml

repeat salbutamol every 20 minutes

+ ipratropium bromide 250mcg in 1 mL nebulised

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What are the results of gas trapping?

leads to build up of pressure that reduces blood flow and bp

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What are symptoms of MODERATE asthma?

breathless when talking
prefer to sit
agitation
speaking in phases
increased RR
accessory muscles
Peak expiratory flow rate ar between 60 - 80%

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What are the effects of ventilation of asthma?

increases resistance to airflow

- Causes hypoventilation at alveoli level

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How does salbutamol work?

Short acting B2 agonist
bronchodilator
only 10-15% of drug is retained in lungs

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What are the 3 components to the pathophysiology of asthma?

Bronchospasm
Mucosal oedema
Mucous plugging

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What are symptoms of FATAL asthma?

sever bronchospasm
Mucous plugging

Which leads to asphyxia
and
Cardiac arrythmias due to:
- hypoxia
- air trapping may tamponade the heart

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What are some conditions that present with a wheeze similiar to asthma?

acute heart failure (cardiac asthma)
UAO
multiple pulmonary emboli
Aspiration of foreign body or gastric acid
tumours/disorders causing endobronchial obstruction
interstitial lung disease
vocal cord dysfunction
anaphylaxis

What is the target assisted ventilation rate for an unconscious paediatric asthmatic patient?

Ventilate:
small child 12-15 ventilations
medium child - 10-14 ventilations
Then manage as per critical asthma

What does it mean if you hear inspiratory wheezes as well as expiratory wheezes in asthma?

means larger airways are also obstructed with secretions

What is meant by ventilation/perfusion mismatch?

an area of lung that is being perfused but not being ventilated )or vice versa) reducing gas exchange

Causes hypoxia and hypoxaemia - oxygen is not getting into blood
Causes hypercapnia - co2 not getting out of blood

What are symptoms of SEVERE asthma?

- resting dyspnoea - upright position - inability to speak (words only) - resp rate over 3o - accessory muscle use - retractions - HR over 120 - Pulsus paradoxus over 10mmHg (a large decrease in SBP and pulse wave amplitude during inspiration) - Lowered level of consciousness (agitated) - Sweating - Pallor

What are conditions caused by gas trapping?

- Tension pneumothorax | - Hypotension and bradycardia

What do you do if a paediatric asthmatic patient loses cardiac output?

- allow apnoea for 30 seconds exclude TPT gentle lateral chest pressure

What are the contraindications for ipratropium bromide?

hypersensitivity to ATROPINE or its derivatives

What is the target assisted ventilation rate for an unconscious asthmatic patient?

6-7mls/kg @5-8 ventilations per minute Allow for prolonged expiratory phase

What is and what are symptoms of STATUS ATHMATICUS?

acute severe asthma attack Does not improve with usual doses of bronchodilators or steroids Symptoms: - hypoxemia, tachypnea, tachycardia, accessory muscles use, wheezing

what is the treatment for an inadequate response to the severe treatment for asthma for an adult as per AV CPGs?

adrenaline 500mcg IM repeat 500mcg @5-10minute intervals Max dose 1.5mg If no response consult a clinician

Define asthma?

An episodic, reversible, inflammatory condition of the small airways, mediated by trigger factors, and characterised by bronchospasm, mucosal oedema and mucous plugging.

Explain the inflammatory process in the body

1. Antigen enters body 2. Plasma cells produce antibodies 3. Antibodies attach to mast cells in body tissue 4. More of the antigen invades 5. Antigen combines with antibody attached to mast cell, triggering degranulation and release of histamine 6. histamine causes blood vessels to dilate and become leaky, which promotes oedema, stimulates secretion of mucus and causes smooth muscle to contract

define gas trapping?

failure to expire as much as air as a person has taken in

what is the treatment for mild or moderate asthma for a paediatric as per AV CPGs?

Salbutamol pMDI and spacer 2 - 6 years = 2 - 6 doses >6 = 4 - 12 doses 4 breaths every dose repeat every 20 minutes

What are risk factors for asthma?

- past history - over 2 hospitalisations in past year - over 3 ED visits in past year - Over 2 canisters per month of salbutamol - Low socio-economic or inner-city resident - Illicit drug use

How much adrenaline do you give during thunderstorm asthma?

Adrenaline IV 20mg every 2 minutes

What are the contraindications of salbutamol?

nil

What do you do if an asthmatic patient loses cardiac output?

- allow apnoea for 1 minute if CO returns then ventilate - no CO return treat as cardiac arrest

What are the side effects of adrenaline?

``` sinus tachy supraventricular rhythms ventricular arryhtmias hypertension pupillary dilation may increase size of MI feeling of anxiety or palpitations ```

What are symptoms of asthma?

- Cough - Wheezing - SOB - Chest tightness - Prolonged expiratory phase Other symptoms: - Sputum production - Fever

What percentage of the Aus population has asthma?

Approx 11% - 2.5milli peeps

What are the side effects of dexamethasone?

nil

what is the treatment for critical asthma for a paediatric as per AV CPGs?

Salbutamol 10mg in 5ml nebulised (repeat 5mg in 2.5ml every 5 minutes) Iprotropium bromide 250mcg in 1mL nebulised + adrenaline 10mcg/kg IM repeat every 5-10 mins max 30mcg/kg + Dexamethasone 600mcg IV/Oral max 12mg

What are the contraindications for dexamethasone?

hypersensitivity

What is the upper airway lined with?

Mucous secreting cells (goblet cells) and cilia to trap foreign bodies Larger airways have cartilage due to high airflow.

what is the treatment for mild or moderate asthma for an adult as per AV CPGs?

Salbutamol pMDI and spacer - 4-12 doses 4 breaths per dose

What are the side effects of ipratropium bromide?

- headache - nausea - dry mouth - skin rash - tachycardia - palpations

What happens to the airway during asthma?

- Narrowed airway - Tightened muscles contrict airway - inflammed thickened airway wall - Mucous production

What is the width of the bronchioles?

Less than 1mm Bronchioles do not have connective tissue or cartilage, made of smooth muscle

What are symptoms of MILD asthma?

breathless only with activity able to lie down talk in long sentances RR may be elevated with no accessory muscles Expiratory wheezes Peak expiratory flow rate (PERF's) are more than 80%

What is the concentration of IV adrenaline for thunderstorm asthma?

10mcg per mL which will be 20mcg in 2mL