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Flashcards in Paeds: Management of acute Asthma HW Deck (7)
1

Moderate asthma exacerbations

- Worsening of symptoms
- PEFR 50-75% of predicte or best
- Speech normal
- RR >30 bpm
- Pulse >120bpm

2

Severe asthma attack

- Can't complete sentences/too breathless to speak or feed
- RR: Adults >25 bpm. Children >30 bpm. Under 5s >50bpm
- Pulse: Adults >110 bpm. Children 120 bpm. Under 5's 130 bpm
- PEFR 33-50% predicted or best

3

Life-threatening asthma attack

- PEFR

4

Near fatal asthma attack

Increase in PaCo2 and/or requiring mechanical ventilation with raised inflation pressure

5

Management of acute asthma

- Oxygen -high flow 40-60%
- Nebulised salbutamol ( + ipratropium bromide if acute severe of life-threatening attack).
- systemic corticosteroids - Oral prednisolone or iv hydrocortisone (if unable to swallow)
- IV fluids - Also K+ supplements may be neccessary as repeat salbutamol reduced serum K+
- Aminophylline or iv magnesium if 1. life threatening attack or 2. Poor response to Nebulised bronchodilators

6

Indications for assisted ventilation in acute severe asthma:

- Coma
- Respiratory arrest
- Deterioration of ABG (reduced PaO2 ± raised PaCO2 ± ph reduced)
- Exhaustion, confusion, drowsiness

7

Discharge

- Should be stable on discharge meds (nebulised therapy discontinued for 24 hours)
- PEF 75% of predicted or best
- Appointment with GP/asthma nurse in 2 working days and follow-up at specialist hospital clinic in a month.

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