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A - MSRA Paediatrics [15] > [5] Acute Asthma Exacerbation > Flashcards

[5] Acute Asthma Exacerbation Flashcards

1
Q

What is an asthma exacerbation?

A

An acute episode of airflow obstruction occurring on a background of chronic airway inflammation and airway hyper-responsiveness

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2
Q

What initiates an asthma exacerbation?

A

A trigger

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3
Q

What might trigger an asthma exacerbation?

A
  • Viral or bacterial infection
  • Inhaled allergens
  • Environmental irritants
  • Emotion
  • Medication
  • Poor adherence to preventative therapy
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4
Q

How does a trigger cause an asthma exacerbation?

A

It causes bronchoconstriction and increased mucus production, thereby worsening asthma symptoms

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5
Q

What should be noted in the history with each acute asthma attack?

A
  • Duration of symptoms
  • Treatment already given
  • Course of previous attack
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6
Q

What are the classifications of asthma attacks?

A
  • Moderate
  • Severe
  • Life threatening
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7
Q

Can the patient talk in a moderate asthma attack?

A

Yes

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8
Q

What are the oxygen saturations in a moderate asthma attack?

A

> 92%

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9
Q

What is the peak flow in a moderate asthma attack?

A

probs over 50% idk this card was wrong before lol cba to look it up

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10
Q

What is the respiratory rate in a moderate asthma attack?

A
  • ≤40 breaths/min in 2-5 years
  • ≤30 breaths/min in 5-12 years
  • ≤25 breaths/min in 12-18 years
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11
Q

What is the heart rate in a moderate asthma attack?

A
  • ≤140 BPM in 2-5 year
  • ≤30 BPM in 5-12 years
  • ≤25 BPM in 12-18 years
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12
Q

Can the patient talk in a severe asthma attack?

A

No, too breathless

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13
Q

What are the oxygen saturations in a severe asthma attack?

A

<92%

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14
Q

What is the peak flow in a severe asthma attack?

A

33-50%

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15
Q

What is the respiratory rate in a severe asthma attack?

A
  • > 40 breaths/min in 2-5 years
  • > 30 breaths/min in 5-12 years
  • > 25 breaths per min
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16
Q

What is the heart rate in a severe asthma attack?

A
  • > 140BPM in 2-5 years
  • > 125BPM in 5-12 years
  • > 110BPM in 12-18 years
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17
Q

What are the signs of a life threatening asthma attack?

A
  • Silent chest
  • Cyanosis
  • Exhaustion
  • Arrhythmia
  • Hypotension
  • Altered consciousness
18
Q

What is the peak flow in a life threatening asthma attack?

A

> 33%

19
Q

What are the oxygen saturations in a life threatening asthma attack?

A

<92%

20
Q

What are the differential diagnoses for an acute asthma exacerbation?

A
  • Inhaled foreign body
  • Viral-induced infantile wheezing
  • Aspiration
21
Q

When might children with asthma require hospital admission?

A

If, after high dose bronchodilator therapy, they;

  • Have not responded adequately clinically, i.e. there is persisting breathlessness or tachypnoea
  • Are exhausted
  • Still have marked reduction in their predicted, or usual best, peak flow rate or FEV1
  • Have reduced oxygen saturation (<92% in air)
22
Q

Psychologically, what is important when managing an asthma attack?

A

Keep calm and reassure child and parents

23
Q

What is involved in the management of a moderate asthma attack?

A
  • Short acting ß2 agonist via spacer, with face mask under 3
  • Oral prednisolone 1-2mg/kg, maximum 40mg
  • Monitor response for 15-30 minutes
24
Q

What dose of short acting ß2 agonist is given in a moderate asthma attack?

A

2-4 puffs, increasing by 2 puffs every 2 minutes, up to 10 puffs if required

25
Q

What is involved in the management of severe asthma?

A
  • Give high flow oxygen
  • Short acting ß2 agonist via spacer or nebulised
  • Oral prednisolone or IV hydrocortisone
26
Q

What dose of short acting ß2 agonist is given in severe asthma?

A

2.5mg salbutamol in <8 years, 5mg in >8 years. Assess response and repeat as required

27
Q

What additional treatments can be considered in acute severe asthma?

A
  • Inhaled ipratropium or IV ß2-agonist
  • Aminophylline
  • Magnesium
28
Q

What is the involved in the management of life-threatening acute asthma?

A
  • High flow oxygen
  • Short acting ß2 agonist nebulised
  • Oral prednisolone or IV hydrocortisone
  • Nebulised ipratropium
29
Q

What dose of short acting ß2 agonist is given in life-threatening acute asthma?

A

2.5mg salbutamol in <8 years, 5mg in >8 years. Assess response continuously and repeat as required

30
Q

What additional therapies can be considered in life-threatening acute asthma?

A
  • IV ß2 agonist
  • Aminophylline
  • Magnesium
31
Q

Who should patients with life threatening acute asthma be discussed with?

A

PICU

32
Q

What should be done after initial treatment in asthma?

A

Assess response

33
Q

What should be done if responding to initial treatment for asthma?

A
  • Continue bronchodilators 1-4 hours prn
  • Discharge when stable on 4h treatment
  • Continue oral prednisolone for 3-7 days
34
Q

What should be done if not responding to initial treatment in acute asthma?

A
  • Transfer to HDU/PICU
  • Ensure senior medical review
  • Consider IV therapies if not already used
  • Consider CXR and blood gases
  • Consider need for mechanical ventilation
35
Q

What IV therapies can be considered in acute asthma when the patient is not responding?

A
  • Magnesium
  • Aminophylline
  • ß2 agonists
36
Q

What is the purpose of a CXR when acute asthma is not responding?

A

Check for pneumothorax and infection

37
Q

What should be reviewed with the family prior to discharge from hospital after an acute admission?

A
  • When drugs are used (regularly or ‘as required’
  • How to use the drug (inhaler technique)
  • What each drug does (relief vs prevention)
  • How often and how much can be used
  • What to do if asthma worsens
  • What indicates poorly controlled asthma
38
Q

What should be done to aid the patient and parents in knowing what to do if asthma worsens?

A

A personalised written asthma management action plan should be compiled

39
Q

What things should parents be made aware of that indicate poorly controlled asthma?

A
  • Increasing cough, wheeze, or breathlessness
  • Difficult walking, talking, or sleeping
  • Decreasing relief from bronchodilators
40
Q

What can be done in asthmatics who find it difficult to identify a gradual deterioration?

A

Home measurement of peak flow rate may be helpful

41
Q

Why is it to important education in the management of asthma?

A

Outcomes are better for children with a package of educational measures

42
Q

Has any single component of educational measures in asthma been shown to be beneficial?

A

No

A - MSRA Paediatrics [15] (115 decks)

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