acute asthma exacerbation Flashcards
Lifetime prevalence of asthma in Canadian children?
11-16%
Asthma exacerbations account for ___ % of all pediatric ED visits in Canada?
3-7%
Risk factors for PICU admission with asthma exacerbation?
- previous life-threatening events
- admissions to PICU
- intubation
- deterioration while on systemic steroids
Classification of mild asthma?
- mental status
- activity
- speech
- WOB
- auscultation
- SpO2
- peak flow vs personal best
- mental status = normal
- activity = normal/exertional dyspnoea
- speech = normal
- WOB = minimal intercostal retractions
- auscultation = moderate wheeze
- SpO2 = >94%
- peak flow vs personal best = >80%
Classification of moderate asthma?
- mental status
- activity
- speech
- WOB
- auscultation
- SpO2
- peak flow vs personal best
- mental status = might be agitated
- activity = decreased activity/feeding
- speech =speaks in phrases
- WOB = intercostal and subcostal retractions
- auscultation = pan-expiratory and inspiratory wheeze
- SpO2 =91-94%
- peak flow vs personal best = 60-80%
Classification of severe asthma?
- mental status
- activity
- speech
- WOB
- auscultation
- SpO2
- peak flow vs personal best
- mental status = agitated
- activity = decreased activity/stops feeding
- speech = speaks in words
- WOB = accessory muscle use, nasal flaring, paradoxical thoracoabdominal movements
- auscultation = wheezes audible without stethescope
- SpO2 =
Classification of impending respiratory failure?
- mental status
- activity
- speech
- WOB
- auscultation
- SpO2
- peak flow vs personal best
- mental status = obtunded
- activity = unable to eat
- speech = unable to speak
- WOB = marked distress as with severe asthma
- auscultation = silent chest
- SpO2 =
Salbutamol side effects?
- tachycardia
- hyperglycemia
- hypokalemia
Patients receiving continuous salbutamol therapy should be monitored for cardiac arrhythmia (not documented in children but in adults).
Ipratropium bromide should be used cautiously in children with ____ allergy.
Soy
Oral corticosteroids given for asthma exacerbations are best dosed when?
Once daily in the morning to decrease risk of adrenal suppression (cortisol peaks in the morning).
Risk of intubating an asthmatic?
Up to 26% have complications (pneumothorax, impaired venous return, cardiovascular collapse) due to increased intrathoracic pressure.
Admission criteria for asthmatic from ED?
- supplemental O2 needs
- increased WOB
- B agonists needed more than q4h after initial tx
- deterioration while on systemic steroids
Discharge criteria from PICU?
- B agonists needed less than q4h
- SpO2 >94% RA
- minimal respiratory distress
- improved AE
Side effects of inhaled corticosteroids?
Potential adrenal suppression - but this risk is minimized with proper monitoring.
They do NOT impair growth/affect final adult height.
Minimum age licensed in Canada for inhaled corticosteroids?
Beclomethasone (QVAR) - 5 yrs
Budesonide (Pulmicort) - 6 years
Fluticasone (Flovent) - 12 months
Ciclesonide (Alvesco) - 6 years
