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Flashcards in FN: Acute Severe Asthma Deck (16):
1

Presentation

Acute breathessness and wheeze

2

History

1. Precipitant: infection, travel, excercise
2. Usually and recent treatment
3. Previous attacks and severity: ICU?
4. Best PEFR?

3

Investigations

1. PEFR
2. ABG
3. FBC, U + E, CRP, blood cultures

4

ABG's show

PaO2 usually normal or slightly reduced
PaCO2 reduced
If PaCO3 increased: send to ITU for ventilation

5

Assesment severe any one of the following

1. PEFR 25
3. HR>110
4. Cant complete sentence in one breath

6

Life threatening: any one of

1. PEFR 4.6 kPa, PaO2<8kPa
3. cyanosis
4. Hypotension
5. Exhaustion, confusion
6. Silent chest, poor respiratory effort
7. Tachy-/brady/arrhythmias

7

Differential

Pneumothorax
Acute exacerbation of COPD
Pulmonary oedema

8

Admission criteria

1. Life-threatening attack
2. Feature of severe attack persisting despite initial treatment
3. May discharge if PEFR>75% 1h after intial Rx

9

Discharge when

1. Been stable on discharge meds for 24hr
2. PEFR>75% with diurnal variability <20%

10

Discharge Plan

1. TAME pt.
2. PO steroids for 5d
3. GP appointment w/i 1 wk
4. Resp clinic appointment w/i 1 mo

11

Management

1. O2, Nebs and steroids
2. If life threatening:inform ITU, MgSO4 IVI, nebulised salbutamol
3. If improving
4. IV treatment if no improvement in 15-30mins
5. Monitoring

12

O2, Nebs and steroids

1. Sit-up
2. 100% O2 via non-rebreathe mask (aim for 94-98%)
3. Nebulised salbutamol (5mg) and ipratropium (0.5mg)
4. hydrocortisone 100mg IV or pred 50mg PO (or both)
5. Write "no sedation" on drug chart

13

If life threatening

1. Inform ITU
2. MgSO4 2g IVI over 20 min
3. Nebulised salbutamol every 15min (monitoring ECG)

14

If improving

1. Monitoring: SpO2 @ 92-94%, PEFR
2. Continue pred 50mg OD for 5 days
3. Nebulised salbutamol every 4hrs

15

IV treatment if no improvement in 15-30 min:

1. Nebulised salbutamol every 15min (monitor ECG)
2. Continue ipratropium 0.5mg 4-6 hrly
3. MgSO4 2g IVI over 20 min
3. Salbutamol IVI 2-30ug/min
4. Consider aminophylline
a. Load:5mg/kg IVI over 20min: unless already on theophylline
b. Continue:0.5mg/kg/hr
c.Monitor levels

5. ITU transfer for invasive ventilation

16

Monitoring

1. PEFR every 15-30min: pre- and post beta agonist
2. SpO2: keep >92%
3. ABG if initial PaCO2 normal or increased

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