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Acute Severe Asthma

Title               

Ñ    Acute Severe Asthma

Definition

Severe Attack

Ñ    Unable to complete sentences

Ñ    Respiratory rate > 25 /min

Ñ    Pulse rate >110 beats per minute

Ñ    Peak expiratory flow rate < 50% of predicted or best

Life Threatening Attack

Ñ    Silent chest, feeble respiratory rate

Ñ    Cyanosis

Ñ    Bradycardia or hypotension

Ñ    Exhaustion

Ñ    Confusion, coma

Ñ    Peak expiratory flow rate < 33 % of predicted or best

Ñ    Arterial Blood Gases:

PaCO₂ normal or high

PaO2 < 8 kPa

pH low

Clinical Features

History

E&M

Ñ    Exhaustion:

Life threatening

Examination

IS

Ñ    Cyanosis:

Life threatening

CVS

Ñ    Pulse > 110 min:

Severe attack

Ñ    Bradycardia, hypotension:

Life threatening

RS

Ñ    Respiratory rate > 25 /min:

Severe attack

Ñ    Feeble respiratory effort, silent chest:

Life threatening

CNS

Ñ    Confusion, coma:

Life threatening

Investigations

Fluids

Blood

Biochemistry

Ñ    Arterial Blood Gases:

Life threatening:

·          P_aCO₂ normal or high

·          P_aO₂ < 8 kPa

·          pH low

Imaging

Chest X-ray

Ñ    Exclude pneumothorax

Physiological studies

Pulmonary Function Tests

Ñ    Peak flow < 50% predicted or best:

Severe attack

Ñ    Peak flow < 33 % predicted or best:

Life threatening

Management

Control

Drugs

Ñ    High flow oxygen:

100 % via non-rebreathing bag

Ñ    Nebulised b₂-agonist:

Salbutamol

Ñ    Nebulised antimuscarinic:

        Ipratropium

Ñ    Steroids:

Intravenous, oral or both

Ñ    Magnesium sulphate

Ñ    Aminophylline:

Loading dose, infusion

Equipment

Ñ    Nebulise using oxygen

Support

Residence

Ñ    ITU in life threatening situation

Equipment

Ñ    Invasive ventilatory support:

Intubation and ventilation

Indications:

·          Tired, drowsy, confused

·          Hypercapnoea

·          Hypoxic despite optimal therapy

·          Comatose

·          Respiratory arrest

Prevention

Drugs

Ñ    Steroid and bronchodilator therapy

Equipment

Ñ    Peak flow meter:

Monitor disease

Ñ    Correct inhaler technique

Prognosis

Ñ    Significant mortality

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