Management of acute asthma

Question 1

Define an acute asthma attack?

Answer 1

One that cannot be controlled by the use of standard medication

Question 2

State the 3 components of moderate acute asthma attack

Answer 2

Increasing symptoms
PEF >50-75% of best/predicted
No features of a severe asthma attack

Question 3

State the 4 features of an acute asthma attack

Answer 3

Any of the following:

PEF 33-50% of best/predicted
Resp rate >/= 25/min
HR >/= 110/min
Inability to speak in complete sentences in one breath

Question 4

State the 7 clinical signs of a life-threatening attack

Answer 4

Altered consiousness level
Exhaustion
Arrhythmia
Hypotension
Cyanosis
Silent chest
Poor resp effort

Question 5

What are the 4 measurments that classify as a life-threatening attack?

Answer 5

PEF <33% best/predicted
SpO2 <92%
PaO2 <8kPa
Normal PaCO2 (4.6-6.0)

Question 6

What are the 2 features of a near fatal asthma attack?

Answer 6

Raised PaCO2 (<2kPa)
Requiring mechanical ventilation with raised inflation pressures

Question 7

What are the 3 possible investigations that can be done in a severe asthma attack?

Answer 7

PEV/FEV1
Pulse ox/ABG
CXR

Question 8

When would a CXR be indicated in asthma attacks? (5)

Answer 8

Suspected pneumothorax
Suspected lung consolidation
Life-threatening attacks
Failure to respond to treatment
If ventilation is required

Question 9

What are the 5 initial assessments that can be done to determine the severity of an asthma attack?

Answer 9

PEF
Ability to speak
RR
Pulse
O2 sats

Question 10

What are the 3 components of the immediate treatment of an asthma attack?

Answer 10

Salbutamol 5mg (or terbutaline 10mg) nebulised
Hydrocortisone 100mg IV (or prednisolone 40-50mg orally)
Oxygen if low sats

Question 11

If life-threatening asthma attack features are present, what 3 things should be administered?

Answer 11

Nebulised Salbutamol every 15 mins
Ipatropium 0.5mg in nebs
Magnesium sulfate 1.2-2g IV over 20 mins

Question 12

Who are the 2 people that should be informed if an asthma attack has life-threatening features?

Answer 12

ICU

Seniors

Question 13

What should be monitored when administering a lot of salbutamol?

Answer 13

ECG for arrhythmias

Question 14

What 2 things should be considered if a life-threatening asthma attack is not improving after medication?

Answer 14

Ventilatory support

Intensification of medication

Question 15

What 2 meds could be administered as 2nd line in a life-threatening attack?

Answer 15

Aminophylline

IV salbutamol

Question 16

If a life-threatening attack improves within 15-20 mins, what 3 things should be done?

Answer 16

Nebulised salbutamol every 4 hrs
Prednisolone 40-50mt orally for 5-7 hours
Monitor peak flow and sats

Question 17

State the components of O SHIT MAn

Answer 17

Oxygen (100% non-rebreather)
Salbutamol (nebulised)
Hydrocortisone IV (or prednisolone)
Ipratropium (nebulised)
Theophylline IV (or aminophylline IV)
Magnesium -  and call an
Anesthetist