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PAR2012 - Respiratory > Week 5 > Flashcards

Week 5 Flashcards

1
Q

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

A

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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2
Q

What is the presentation of dexamethasone?

A

8mg in 2ML

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3
Q

What is the presentation of ipratropium bromide?

A

250mcg in 1mL

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4
Q

What are the contraindications for adrenaline?

A

Hypovolaemic shock without adequate fluid replacement

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5
Q

What is the response of histamine?

A

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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6
Q

What are the permanent airway changes due to asthma?

A

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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7
Q

What is the presentation of adrenaline?

A

1mg in 1mL

or

1mg in 10mL

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8
Q

What is the last branch of the conducting airway?

A

Terminal bronchioles - where gas exchange occurs

More than 32k terminal bronchioles

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9
Q

What is the patterns of asthma?

A
  • Perennial and or seasonal
  • Continual or episodic
  • Onset
  • Duration
  • Frequency
  • Aggravating factors
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10
Q

What are side effects of salbutamol?

A

sinus tachy
muscle tremor

others:

  • anxiety
  • headache
  • dry mouth
  • palpitation
  • muscle cramps
  • flushing
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11
Q

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

A
  • 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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12
Q

What is the presentation of salbutamol?

A

5mg in 2.5mL

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13
Q

What are some triger factors for Asthma?

A
  • Pollen
  • Exercise
  • Allergens
  • Resp infections
  • Drugs
  • Foods
  • Gastro-oesophageal reflux disease
  • Smoking
  • Air pollutants
  • Occupational factors
  • Temperature change
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14
Q

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

A 
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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15
Q

What are the results of gas trapping?

A

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

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16
Q

What are symptoms of MODERATE asthma?

A 
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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17
Q

What are the effects of ventilation of asthma?

A
  • increases resistance to airflow

- Causes hypoventilation at alveoli level

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18
Q

How does salbutamol work?

A

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

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19
Q

What are the 3 components to the pathophysiology of asthma?

A
  1. Bronchospasm
  2. Mucosal oedema
  3. Mucous plugging
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20
Q

What are symptoms of FATAL asthma?

A
  • sever bronchospasm
  • Mucous plugging
Which leads to asphyxia
and
Cardiac arrythmias due to:
- hypoxia
- air trapping may tamponade the heart
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21
Q

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

A
  • 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
22
Q

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

A

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

23
Q

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

A

means larger airways are also obstructed with secretions

24
Q

What is meant by ventilation/perfusion mismatch?

A

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

25
Q

What are symptoms of SEVERE asthma?

A
  • 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
26
Q

What are conditions caused by gas trapping?

A
  • Tension pneumothorax

- Hypotension and bradycardia

27
Q

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

A
  • allow apnoea for 30 seconds
    exclude TPT
    gentle lateral chest pressure
28
Q

What are the contraindications for ipratropium bromide?

A

hypersensitivity to ATROPINE or its derivatives

29
Q

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

A

6-7mls/kg
@5-8 ventilations per minute

Allow for prolonged expiratory phase

30
Q

What is and what are symptoms of STATUS ATHMATICUS?

A

acute severe asthma attack

Does not improve with usual doses of bronchodilators or steroids

Symptoms:
- hypoxemia, tachypnea, tachycardia, accessory muscles use, wheezing

31
Q

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

A

adrenaline 500mcg IM
repeat 500mcg @5-10minute intervals
Max dose 1.5mg

If no response consult a clinician

32
Q

Define asthma?

A

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

33
Q

Explain the inflammatory process in the body

A
  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
34
Q

define gas trapping?

A

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

35
Q

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

A

Salbutamol pMDI and spacer
2 - 6 years = 2 - 6 doses
>6 = 4 - 12 doses

4 breaths every dose
repeat every 20 minutes

36
Q

What are risk factors for asthma?

A
  • 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
37
Q

How much adrenaline do you give during thunderstorm asthma?

A

Adrenaline IV 20mg every 2 minutes

38
Q

What are the contraindications of salbutamol?

A

nil

39
Q

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

A
  • allow apnoea for 1 minute

if CO returns then ventilate
- no CO return treat as cardiac arrest

40
Q

What are the side effects of adrenaline?

A 
sinus tachy
supraventricular rhythms
ventricular arryhtmias
hypertension
pupillary dilation
may increase size of MI
feeling of anxiety or palpitations
41
Q

What are symptoms of asthma?

A
  • Cough
  • Wheezing
  • SOB
  • Chest tightness
  • Prolonged expiratory phase

Other symptoms:

  • Sputum production
  • Fever
42
Q

What percentage of the Aus population has asthma?

A

Approx 11% - 2.5milli peeps

43
Q

What are the side effects of dexamethasone?

A

nil

44
Q

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

A

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

45
Q

What are the contraindications for dexamethasone?

A

hypersensitivity

46
Q

What is the upper airway lined with?

A

Mucous secreting cells (goblet cells) and cilia to trap foreign bodies

Larger airways have cartilage due to high airflow.

47
Q

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

A

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

48
Q

What are the side effects of ipratropium bromide?

A
  • headache
  • nausea
  • dry mouth
  • skin rash
  • tachycardia
  • palpations
49
Q

What happens to the airway during asthma?

A
  • Narrowed airway
  • Tightened muscles contrict airway
  • inflammed thickened airway wall
  • Mucous production
50
Q

What is the width of the bronchioles?

A

Less than 1mm

Bronchioles do not have connective tissue or cartilage, made of smooth muscle

51
Q

What are symptoms of MILD asthma?

A

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%

52
Q

What is the concentration of IV adrenaline for thunderstorm asthma?

A

10mcg per mL

which will be 20mcg in 2mL

PAR2012 - Respiratory (13 decks)

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