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Flashcards in Managing asthma attacks Deck (10)
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1
Q

What are the criteria for mild asthma exacerbation?

A
  • PEFR >75%

- Very slight worsening of asthma symptoms

2
Q

What are the criteria for moderate asthma exacerbation?

A
  • PEFR <75%
  • Increasing asthma symptoms
  • No features of severe asthma
3
Q

What are the criteria for severe asthma exacerbation?

A

Any ONE of:

  • PEFR 33-50%
  • RR ≥25/min
  • HR ≥110/min
  • Inability to complete sentences in one breath
4
Q

What are the clinical signs of life-threatening asthma exacerbation?

A

Any ONE of the following:

  • Exhaustion
  • Arrhythmia
  • Hypotension
  • Cyanosis
  • Silent chest
  • Poor respiratory effort
5
Q

What measurements indicate life-threatening asthma exacerbation?

A

Any ONE of the following:

  • PEF <33% predicted
  • SpO2 <92%
  • PaO2 <8 kPa
  • ‘Normal PaCO2 (4.6-6.0 kPa)
6
Q

What are the criteria for near-fatal asthma exacerbation?

A
  • Raised PaCO2

- and/or requiring mechanical ventilation with raised inflation pressures

7
Q

What must be prescribed immediately once asthma exacerbation is recognised (adults)?

A

All of these are given together (would be prescribed and given during B part of A-E assessment):

  1. Oxygen (maintain between 94-98%, usually non-rebreathe mask 15L)
  2. Salbutamol 5mg via an oxygen-driven nebuliser
    - repeat at 15-30 minute intervals
  3. Hydrocortisone (IV) 100mg, or Prednisolone tablets 40-50mg
  4. Ipratropium bromide 0.5mg via oxygen-driven nebuliser 4-6 hrly
8
Q

What additional pharmacological agents should be prescribed if asthma exacerbation is life-threatening (adult)?

A
  • Give with senior input
    1. Magnesium sulphate 2g IV over 20 mins
  • one-off dose
    2. Theophylline: aminophylline infusion
    3. Escalate care (intubation and ventilation)
9
Q

At what points during assessing an asthma exacerbation should senior involvement be requested?

A
  1. Any signs of airway obstruction
  2. Reduced air entry suggesting airway compromise
  3. If magnesium sulphate or IV aminophylline needs to be administered
  4. If a patient has a negative response or isn’t responding adequately to boluses of IV fluids
  5. If intracranial pathology is suspected and CT head is indicated
  6. Concerns regarding consciousness/GCS of a patient ESPECIALLY if GCS is 8 or less
  7. Deterioration or no improvement when re-assessing ABCDE
10
Q

What should be done once a patient is stabilised following asthma exacerbation?

A
  1. Take a history
  2. Review notes, charts, recent investigations, current medications
  3. Clearly document your ABCDE assessment (inc history, examination, observations, investigations, interventions, patient’s response)
  4. Discuss patient’s current clinical condition with a senior clinician using SBARR format
    - Are any further assessments or interventions required?
    - Does the patient need a referral to HDU/ICU?
    - Does the patient need reviewing by a specialist?
    - Should any changes be made to the current management of their underlying condition(s)?
  5. Handover