Acute asthma Flashcards
Which A-E does this affect?
Breathing
Airway
is the patient vocalising? Struggling to breathe – assess for obstruction, head tilt chin lift, airway adjuncts, LMA, anaesthetist needed for intubation
Findings:
* tongue swelling
* cough
* cyanosis
* can’t finish sentences
Breathing
Look: increased WOB, tracheal tug, respiratory distress, accessory muscle use, tripoding
Listen: crackles or wheeze, silent chest, decrease breath sounds
Feel: percuss the chest, feel central trachea, reduced chest expansion
O2 low, RR high
Do ABG stat to see gasses (beware of normal or high PaCO2), and XCR to rule out pneumonia
Do PEFR peak flow to quantify
Management:
Start O2 15L via NRM
- Burst step 3 - 2 - 1
3 x Salbutamol nebs 5mg ( increase HR, arrhythmias, tremor, low K)
2 x Ipratropium bromide nebs 0.5 mg
1 x oral prednisolone 50 mg PO (5 day course) - IV step
IV salbutamol
IV magnesium sulphate 1.2 g - 2 g / 20 minutes
IV steroids (100 mg hydrocortisone IV) - infusion
Salbutamol
Aminophylline - Intubate and ventilate
IF LIFE THREATENING: 2222 Escalate to anaesthetics and ITU
Stratification of risk
Mild-Moderate
* PEFR 50-75%
* Can speak
Severe
* PEFR 33-50%
* Inability to complete sentences
* RR>25
* HR>110 bpm
Life-threatening
* PEFR <33%
* Silent chest
* Cyanosis
* Arrhythmia
* Exhaustion, confusion, coma
Near fatal
* Normal CO2 / high CO2
Circulation
Look: anaemia, cyanosis
Listen: S1,2+0
Feel: CRT, pulse
HR, BP (tachycardic)
ECG important before salbutamol
Bloods:
FBC, UEs, LFTs, CRP
Cannulas for IV access
- fluid bolus if hypotensive
Disability
PEARL
glucose
Focal neurology
GCS (confused due to CO2 retention)
Exposure
Abdo exam
Rashes
Catheter (monitor output)
Temperature
Drug chart: level of asthma care
Long term:
* Inhaler technique
* Asthma nurse
* Triggers
* GP appointment 2 days
* Resp appointment 4 weeks
Management overall
