Respiratory disorders and their management II Flashcards
Asthma prevalence?
5.4 million UK
1 in 12 adults, 1 in 11 child
Anxious pt, becomes SOB, uses blue inhaler but isn’t making a difference.
What history would you do?
Duration of onset of symptoms
Any infective features/triggers - dust, pets, anxiety
Severity of illness - previous hospital admissions
Other meds
Anxious pt, becomes SOB, uses blue inhaler but isn’t making a difference.
What signs will be seen on examination?
What bedside tests can you do to measure the severity?
Elevated resp rate Inability to complete sentences Peripheral/central cyanosis Audible wheeze Tachycardia
Measure HR, resp rate, peak flow meter
Symptoms of asthma?
Wheeze Cough Chest tightness Dyspnea Nocturnal duration Possible triggers - exertion, dust, temp change, emotional status, occupation
Signs of asthma?
Eczema Nasal polyps Cushingoid Wheeze Exacerbation - assess RR, HR, SpO2, ability to speak
How to diagnose asthma?
Measure their peak flow - see if there’s a fluctuation of 20% = asthmatic
Suspected asthma = Trail of inhaled steroids (beta agonists) = if works = diagnose asthma
How to deliver inhaled drugs?
Meter dose inhaler (SABA/LABA/Ipatropium/ICS
MDI via spacer (4 puffs initially then 2 puffs every 2 mins up to max 10 puffs)
Breath actuated inhalers e.g. turbohaler
Pts at risk of near fatal or fatal asthma?
Not taking treatment Not going to GP Previous near fatal asthma Heavy use of beta agonist Self discharge from hospital Obesity Denial Alcohol or drug abuse Income problems
Acute asthma severity - what to measure?
- Mild - PEF best 75+
- Moderate - PEF best 50-75
- Severe PEF best 33-49, resp rate >25/min, HR >110/min, no talking
LT PEF best <33, HR bradycardia, SaO2<92, silent chest
What to do in an asthmatic emergency?
Beta agonists
Steroids asap
Anticholinergics with beta agonists
