Asthma SIM workshop Flashcards
What is the triad of key pathophysiological processes in asthma?
Bronchospasm
Airway oedema
Mucus production
What are the key symptoms of asthma?
Coughing
Wheezing
Chest tightness
Shortness of breath
What are the key signs of asthma?
Wheeze on ausculation
Cyanosis
Fine tremor
Asterixis
Reduced chest expansion
Tachypnoea
Accessory muscle breathing
What is a MART regime in asthma treatment?
A combination inhaler rather than two seperate relieve nad preventer inhalers
This inhaler can be taken regularly to reduce inflammation of the lungs (usually twice a day) and also during an asthma attack.
Contains a steroid (budesonide) and a LABA (formeterol)
What are the key things to do in the acute management of asthma?
Deliver oxygen - 15L non-rebreath mask - to prevent hypoxia
Salbutamol - open up airways
Steroids - reduce inflammatory response
Make require nebuliser or oral.
Assess the severity and escalate early is needed
What health and lifestyle advice should be used in the long term management of asthma?
Smoking cessation
Trigger avoidance
PEFR diary
Vaccination - influenza and pneumococcal
Regular asthma reviews - to create a personalise asthma care plane considering PEFR recording and safety netting advice, ensure correct inhaler technique
What is the key difference between asthma and allergies?
Asthma - affects the airways only, mediated by IgE or other immunological process, typically has a diurnal pattern and worse on exposure
Allergy - effect skin, eyes, nose etc any part of the body including airway if severe such as in anaphylaxis, mediated by lots of hypersensitivity responses including IgE, typically worse on exposure to the allergen only.
When is an asthmatic wheeze often heard?
What causes it?
During expiration
A polyphonic sound due to hyperresponsiveness of the airways - all different diameters**
When is a stridor sound best heard?
During inspiration
Indicates an upper airway obstruction/narrowing
High pitched
What is important to remember clinically when looking at an ashtmatics ABG during an asthma attack?
Tachypnoea causes asthmatic to loose more CO2, should expect to be below normal range
If CO2 is within normal range indicates CO2 retention - consider T2RF - escalate immediately.
May co-present with drowsiness due to hypercapnia.
During oxygen therapy what is the goal range of SpO2 to maintain?
94-98% in most patients
COPD or chronic CO2 retainers may have a lower goal.
When might an asthmatic require an ABG analysis?
SpO2 less than 92%
Or other features of life-threatening asthma.
When might a chest X ray be ordered for an asthmatic?
Is not routine
May be needed if:
- suspected pneumomediastinum or pneumothorax
- suspected consolidation
-life threatening asthma
- failure to respond to treatment satisfactorily
- requirement for ventilation.
What is the use of ipratropium bromide in asthma?
Is a short-acting muscarinic receptor antagonist.
Competitive antagonsit at M£ receptors.
Prevents ACh from binding to receptor, G protein not activated, PLC not activated, Ca2+ levels remain low in smooth muscle
This prevents bronchoconstriction.
What are the diagnostic criteria for moderate asthma?
Increasing symptoms
PEF 5–70% best or predicted
No features of acute severe asthma
