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  • Acute Asthma Exacerbation

    Загружено:

    Roa Al-Sajjan
    285 просмотров3 страницы
    1. This document outlines the steps for assessing and treating an acute asthma exacerbation. 2. It describes performing an ABCDE assessment, obtaining a history, conducting a physical exam, ordering investigations, and initially treating with supplemental oxygen, inhaled bronchodilators, and systemic steroids. 3. The document also provides criteria for classifying exacerbation severity, guidelines for assessing response to initial treatment and determining need for continued treatment, admission, or transfer to the ICU.

    Исходное описание:

    OSCE oriented review of asthma exacerbation, including history, physical examination and management

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    © Attribution Non-Commercial (BY-NC)

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    1. This document outlines the steps for assessing and treating an acute asthma exacerbation. 2. It describes performing an ABCDE assessment, obtaining a history, conducting a physical exam, ordering investigations, and initially treating with supplemental oxygen, inhaled bronchodilators, and systemic steroids. 3. The document also provides criteria for classifying exacerbation severity, guidelines for assessing response to initial treatment and determining need for continued treatment, admission, or transfer to the ICU.

    Авторское право:

    Attribution Non-Commercial (BY-NC)
    Скачайте в формате DOCX, PDF, TXT или читайте онлайн в Scribd
    Отметить как неприемлемый контент
    285 просмотров3 страницы

    Acute Asthma Exacerbation

    Загружено:

    Roa Al-Sajjan
    1. This document outlines the steps for assessing and treating an acute asthma exacerbation. 2. It describes performing an ABCDE assessment, obtaining a history, conducting a physical exam, ordering investigations, and initially treating with supplemental oxygen, inhaled bronchodilators, and systemic steroids. 3. The document also provides criteria for classifying exacerbation severity, guidelines for assessing response to initial treatment and determining need for continued treatment, admission, or transfer to the ICU.

    Авторское право:

    Attribution Non-Commercial (BY-NC)
    Скачайте в формате DOCX, PDF, TXT или читайте онлайн в Scribd
    Отметить как неприемлемый контент
    из 3

    Acute Asthma Exacerbation

    First... Wash hands Introduce yourself Take permission Ensure privacy

    Immediate
    1. ABCs a. Airway: is patient able to talk? If not: head-tilt, chin-lift or jaw thrust +/- adjunct airway if unconscious b. Breathing: RR & O2 saturation i. Supplemental oxygen ii. Give bronchodilator (salbutamol; Ventolin) c. Circulation: i. Pulse, BP ii. IV line, keep open with saline and take blood sample CBC, U&E, blood culture d. Level of consciousness

    History & Examination


    History
    HPI: 1. Dyspnea a. Duration b. Onset (triggers) c. Progression d. Severity (grade it) e. Associated: fever, cough, sputum (color, amount), hemoptysis, wheezing, hyperventilation, hoarseness, chest pain 2. Asthma: a. Duration of asthma b. Follow-up c. Hospitalization d. ICU admission (previous intubation) e. Inhaler refills f. Attacks per month g. Night symptoms h. Current medications (corticosteroids, oxygen etc) & compliance 3. Risk factors/Triggers: recent URTI, allergies, smoking, exercise, aspirin, occupational 4. Other: pregnancy

    Examination
    1. Vital signs: tachycardia, tachypnea, fever? severe: tachycardia >130, pulsus paradoxus 2. General appearance: drowsiness, cyanosis, respiratory distress (use of accessory muscles), inability to speak 3. Chest examination:

    a. Inspection: hyperinflation b. Auscultation: biphasic wheezes, severe: silent chest

    Investigations
    1. Blood: a. CBC: WBC b. U&E 2. ABGs: should be hyperventilation picture (respiratory alkalosis), if acidosis = pending respiratory failure 3. CXR: determine extent of infection if present, exclude pneumothorax 4. PEFR: prolonged; peak flow, FEV1 5. Blood & sputum cultures

    Management
    1. 2. 3. 4. 5. 6. 7. Admit 1st line: Ventolin (albuterol) Atrovent (ipratropium) 2nd line: Systemic steroids (# in pregnancy) 3rd line: theophylline (cardiac toxicity), magnesium sulphate Antibiotics (if infection suspected) If no improvement: consider ICU admission & intubation

    Things You Must Know


    1. Classifying severity: 33, 92 CHEST a. Life-threatening: i. PEFR <33% of predicted ii. O2 saturation <92% iii. Cyanosis iv. Hypotension v. Exhaustion vi. Silent chest vii. Tachycardia b. Severe: i. PEFR <50% ii. RR >25 iii. PR >110 c. Moderate: PEFR <75% d. Mild: PEFR >75%

    History, P/E (HR, RR, O2 sat, use of accessory muscles, auscultation), tests (PEF, ABGs) 1) Supplemental oxygen (until O2 sat >90%) 2) Inhaled B-agonist for 1 hour 3) Systemic steroids (if no response, on oral steroids or very severe)

    Initial Assessment

    Initial Treatmant

    P/E, O2 saturation, PEF

    Reassess in 1 hour

    Moderate episode: -Moderate symptoms, PEF 60-80%

    Severe episode: -Severe symptoms at rest, PEF <60% -Hx of risk factors for near fatal asthma -No improvement with initial Rx

    Continue above treatment for 1-3 hrs

    -Oxygen, inhaled B-agonist, systemic steroids -IV magnesium sulphate

    Reassess after 1-2 hours

    Good response: - Sustained response - Normal P/E - PEF >70%, O2 Sat >90%

    Incomplete response: - Risk factors - Mild-moderate signs - PEF <60% - O2 sat not

    Poor response: - Risk factors - Severe symptoms - PEF <30% - PO2 <65, PCO2 >45

    Discharge

    Admit & monitor

    Admit to ICU & consider mechanical ventilation

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