Ass-thma (Acute) Flashcards
Triggers for acute asthma exacerbation
- RSV
- allergens
- food allergy
- air pollution
- seasonal chagnes
- poor adherence to ICS
Factors that increase asthma-related death
- hx of asthma requiring intubation and mechanical ventilation
- hospitalization or ED visit within past year
- currently or recently on oral CS
- not on an ICS
- overuse of SABA (>1 albuterol/month)
- psychiatric or psychosocial problems
- food allergies
- poor adherence
- comorbidities: PNA, DM, arrhythmias after hospitalization for an asthma exacerbation
Asthma exacerbation treatment goals
- correct hypoxemia if present
- reverse obstruction
- reduce relapse
Acute asthma exacerbation hx assessment
- onset and cause
- severity of symptoms
- all medication use, adherence, adn response to current meds
- risk factors for death
- commorbidities: HF, foregin body, PE, atelectasis
- complications: PNA, anaphylaxis, atelactis, pneumothorax
Acute asthma exacerbation vitals assessment
- temperature
- tachypnea -> if present will proabbly need to treat inpt
- tachycardia -> if present will probably need to treat inpt
- bp
- dry cough
- ability to complete sentences/level of consiousness -> send to acute care facility
- fatigue/somnolence -> treat inpt, airway intervention may be needed
Acute asthma exacerbation respiratory exam assessment
- use of accessory muscles
- wheezing
- diminished breath sounds
- cyanosis
- hypoxic seizures
Acute asthma exacerbation objective assessment
- decreased O2 sasturation (goal is 93-95%, if pt is <90% use aggressive therapy)
- outpatient: PEF or FEV1
- inpatient: ABG
mild-moderate asthma exacerbation presentation
- talks in phrases
- prefers to sitting to laying down
- not agitatd
- RR increased
- accessory muscles may NOT be used
- 100-120 bpm
- O2 sat 90-95%
severe asthma exacerbation presentation
- talks in words (not phrases)
- sits hunched forward
- agitated
- RR >30
- accessory musles in use
- > 120 bpm
- O2 sat <90%
Managing mild-moderate asthma exacerbation in primary care
- SABA (MDI with spacer or nebulizer): 4-10 puffs Q20min for 1 hour
- Prednisolone: 40 mg for adults, 1-2mg/kg for children
- O2 (if available): target 93-95% in adults (94-98% in children)
- assess response at 30min-1 hr
- transfer to acute care facility if worsening
Managing severe asthma exacerbation in primary care
transfer to acute care facility
- pt may receive SABA, ipratropium, O2, and systemic corticosteroid while waiting
Discharging a patient from primary care after an acute asthma exacerbation
discharge if:
- pt should NOT need a SABA
- O2 sat >94%
meds:
- start or step-up maintenance inhaler
- prednisolone: continue for a total of 5-7 days (3-5 in children)
- follow up in 2-7 days
Managing mild-moderate asthma exacerbation in inpatient
- SABA
- consider ipratropium (pt will probs end up on a duoneb) in ED only
- O2 to maintain 93-95% (94-98% in children)
- PO CS - prednisone 50mg po 5-7D
Managing severe asthma exacerbation in acute care facility
- SABA
- ipratropium bromide in ED only
- O2 to maintain 93-95% (94-98% in children)
- PO or IV CS (IV only if pt can’t do PO: e.g. so dyspnec they can’t swallow) - prednisone 50mg po 5-7D
- consider IV Mg 2gm x1 in ED only
- consider high dose ICS in ED only (doesn’t really happen in practice because do you really carry inhalers in ICU?) - if pt does get, give when on discharge
SABA dose for asthma exacerbation that is being treated inpatient
ALBUTEROL
MDI with spacer: 4-8 puufs Q30min for 4hrs then Q1-4 hrs PRN
Neb: 2.5-5mg Q20min x3 then Q1-4hrs PRN (can be done in combo with ipratropium)
