Asthma

Question 0

Moderate criteria

Answer 0

Phrases
Accessory m and tachypnoea
Reduced air entry - prologned end expir wheeze
Sats 94-90

Question 1

Mild criteria

Answer 1

Sentences
Mild tachypnoea accessory m use
Good air entry
Sat >95

Question 2

Severe

Answer 2

1-2 wrd gasps
Agitated, distressed 
Accessory m use
Tachypnoea and tachycardia
Reduced air entry +\- prolonged end expir wheeze
<90 sats

Question 3

Life threatening

Answer 3

Drowsy, lethargic
No talking
Silent chest

Question 5

Treat mod

Answer 5

6-8 puffs ventolin. Large spacer 3 bursts every 20mins
4 mouth piece
\+
Atrovent (ipratrppium bromide) 
6yo 6puffs 
- bursts given 3x 20mins apart
\+ 
PO - prednisolone 1mg/kg (3-5days)

Question 6

Treat severe

Answer 6

• high flow oxygen face mask
• Neb salbutamol
  6yo 5mg continuous x3
  +
  Nebulised atrovent 1ml continuous x3
  +
  PO prednisolone 1ml/kg OR IV hydrocortisone 4mg/kg

Question 7

Life threatening Rx

Answer 7

• Resusc room
• High flow 15L oxygen via face mask.
• If poor ventilation - B n V mask requ
• IV sabutamol 5mcg/kg PUSH –>infusion
• IV adrenaline –> infusion
  consider
• IV hydrocortisone 4mg/kg
• IV MgSo4 40mg/kg over 20mins
• IV aminophilline 6mg/kg over 30mins
  IF inadequate improvement -> intubate
• Ketamine induction
  PICU

Question 8

Stretching criteria

Answer 8

1) examine just prior to next dose
2) resp distress
3) air entry
4) prolonged expiratory phase
5) wheeze - poor predictor

Question 9

D/C criteria asthma

Answer 9

1) sats >94%
2) no resp distress - no accessory m use, no tachypnoea
3) not req salbutamol >3hrly
4) good air entry, min wheeze

Question 10

Tasks for D/C - asthma

Answer 10

1) update Asthma management plan - written and verbal explanation
2) spacer technique
3) asthma educator - booklets
4) explain continued salbutamol 6-8puffs dosing at home. cont 3hrly for today. 4hrly tmr, 6hrly then 8hrly.
5) PO prednisolone 1mg/kg for 3-5 days
6) FU with GP tmr
7) Come back if - increased WOB, req salbutamol more often than 3hrly, new Sx onset that you are worried about. long term - increased trend of daytime/nightime sx.
8) SMOKING - SHS risk to child

Question 11

Second hand smoking risks to child

Answer 11

• reduced lung function
• increased incidence LRTI childhood
• increased early childhood wheeze
• increased asthma in school children