7 June 2014

Assessment of acute asthma (Medical students)

Assessment

History
Too breathless to eat or talk?
Response to reliever?
Previous admission?

Clinical
General condition and consciousness
Cyanosis
HR, RR, BP
Recessions and accessory muscles
Auscultation - air entry, diffuse wheeze

Measurements
PEFR
Pulse oximetry
Venous gases (if iv cannula for hydrocortisone)

Classification

Acute Severe

SpO2 less than 92%
PEF 33-50% best/predicted
Can’t complete sentences in one breath or too breathless to talk or feed
Tachycardia: above 125 (more than 5 years) or above 140 (2 to 5 years)
Tachypnoea: above 30 breaths/min (more than 5 years) or above 40 (2 to 5 years)

Life Threatening

SpO2 less than 92%
PEF less 33% best/predicted
Confusion
Exhaustion
Poor respiratory effort
Silent chest
Cyanosis
Hypotension
Coma

Initial Treatment
  • Oxygen 
  • Nebulized salbutamol, ipratropium 
  • Steroids 
Re-assessment and repeat nebulized salbutamol every 20 minutes as needed. Consult with senior clinician.