Acute asthma exacerbation

Question 1

A 20 year old woman with asthma presents to the ED with severe shortness of breath. How would you assess and manage her?

Answer 1

Impression
Concerned about a severe acute asthma exacerbation in this situation. This is a life-threatening medical emergency that demands emergent assessment and management.

Key DDx to consider;

• anaphylaxis
• FB inhalation
• Cardiac: ACS, APO
• pneumonia, sepsis, PE

Question 2

Acute asthma - assessment

Answer 2

Assessment
- Call for senior help
- A to E particularly paying attention to A/B
A - patent, maintaining. Auscultate for stridor, assess for evidence of angioedema. adjuncts +/- intubation
B - - RR/SP02 monitoring, ascultate for breath sounds, polyphonic wheeze widespread, vs other findings. Severity assessment based on sats and ability to speak (sentences vs single words etc). Assess WOB. Supplemental 02 as required. Administer salbutamol via nebuliser/MDI+spacer according to severity. administer 6-12 puffs STAT + repeat as required of every 20 minutes. Begin stretching according to clinical response
o consider adding corticosteroid
o consider antimuscarinic, mag sulphate, and +/- aminophylline
o regularly re-assess patient
C - cannula, bloods, BP/HR monitoring. if anaphylaxis then fluid resus for BP control
DEFG as per normal

Question 3

Acute asthma - History

Answer 3

History

• PC: onset, progression, duration. ask about triggers. Sx of asthma: wheeze, chest tightness, cough, SOB
• HPC: history of recent control, use of Ventolin? night time sx? coughing? ask about known triggers. underlying atopic illnesses?
• RISKS: smoking, underlying lung disease, fam history, history of hospitalisations etc
• other: meds, allergies, SNAP

Question 4

Acute asthma - Examination

Answer 4

Examination
as per A to E
- vitals
- general appearance
- Resp exam: chest expansion, auscultation for air entry, wheeze, stridor

Question 5

Acute asthma - Investigations

Answer 5

Investigations

• as per A to E
• not relevant here but spirometry and allergy testing

Question 6

Acute asthma - Management

Answer 6

Management
Acute
- as per A to E, utilise pharmacological management and slowly stretch/wean according to clinical response
- consider ICU admission if non-remitting +/- need for intubation
- only discharge if medication can be used at home, appropriate safety netting (when to return, etc0

Ongoing

• counselling
• review asthma management plan
• avoid triggers
• GP follow up and regular review
• lifestyle modifications
• vaccinations + relevant immunisations (influenza, etc)