Asthma (Adult) CPG Notes Flashcards
(27 cards)
Can asthmatic patients initially improve and then deteriorate?
Yes – asthma is dynamic, with rapid deterioration possible.
Should transport be delayed while waiting for MICA backup?
No – consider MICA, but do not delay transport.
Is hypoxaemia an early or late sign in asthma?
A late sign of deterioration.
What should be used throughout patient contact, if available?
Pulse oximetry (SpO₂ monitoring).
Does improvement in SpO₂ always reflect clinical improvement?
No – SpO₂ may improve even if clinical condition is not improving.
What should you suspect in a wheezing patient with no asthma/COPD history?
Heart failure. Rule out other causes of wheeze.
How is adrenaline prepared for infusion?
3 mg adrenaline in 50 mL D5W or Normal Saline.
What infusion rate equals 1 mcg/min?
1 mL/hour.
What is the typical dose range for adrenaline infusion?
2–15 mcg/min.
What is the preferred delivery method for salbutamol in mild/moderate distress?
pMDI with spacer.
What if a pMDI isn’t available?
Nebulise salbutamol 5 mg every 20 minutes as required.
When should a clinician be consulted for IV adrenaline?
• Thunderstorm asthma unresponsive to IM adrenaline
• Orolingual oedema from tPA infusion.
In a large thunderstorm asthma event, can ALS initiate IV adrenaline without a consult?
Yes, if delays to consult are likely and the patient is unresponsive to IM adrenaline.
What is a contraindication to NIV in asthma?
Altered level of consciousness.
What are risks of NIV in asthma?
• Pneumothorax
• Drop in consciousness
• Respiratory failure.
What monitoring must commence ASAP when using BiPAP?
ETCO₂ monitoring.
Who must continuously observe a patient on BiPAP?
At least one MICA paramedic.
What should BiPAP be part of in asthma management?
A comprehensive bundle of care, including adrenaline and pharmacotherapy.
What are the three potential outcomes within 10 minutes of BiPAP initiation?
• Continue BiPAP
• Remove BiPAP
• Consider immediate intubation.
What are signs of BiPAP failure requiring removal?
• No effect (e.g. arrest)
• Worsening vitals
• Mask intolerance or secretions/vomiting
• Paramedic concern for deterioration.
What is the initial FiO₂ setting for BiPAP?
FiO₂ = 1.0.
How should FiO₂ be adjusted once stable?
Titrate to SpO₂ 92–96% depending on pathology.
Can NIV be used if intubation is indicated but declined by ACD?
Yes, even if the patient has reduced GCS.
Can paramedics adjust BiPAP settings independently?
No – changes must be made only after consultation due to risk of barotrauma and reduced venous return.
