Mnagment of asthma in adults and pediatrics by zamzam

Asses thAssess the severity of the attack by carrying out a brief physical examination, including ABCs. IV. Discuss with your
seniors and with the ITU registrar.e sevearity of the attack crying out brief physical examition including abcs

A severe attack is indicated by:

–– PEFR <50% of predicted or best
–– respiratory rate >25/min
–– pulse rate of >110 beats/min
–– inability to complete sentences
A life-threatening attack is suggested by:
–– oxygen saturation <92%
–– silent chest, cyanosis, poor respiratory effort
–– bradycardia, arrhythmia, or hypotension
–– exhaustion, confusion, or coma
• If this is a severe attack, call for senior or specialist help and inform an anaesthetist and the ITU.
Begin treatment immediately.
• Sit the patient up and give 100% oxygen through a non-rebreather mask with a reservoir bag.
• Give 5 mg salbutamol and 0.5 mg ipratropium bromide nebulised with oxygen.
• Give a corticosteroid such as hydrocortisone 100 mg IV, or prednisolone 30–60 mg PO (if the
patient is not too distressed to take tablets).
• Once the patient is stable, carry out investigations including arterial blood gases (ABGs) and
a chest X-ray. A life-threatening attack can be confirmed on ABGs by a PaO 2 < 8 kPa, a PaCO2
> 5 kPa (due to poor respiratory effort), and a pH < 7.35 (due to CO2 retention or lactic acidosis
from tissue ischaemia). ABGs can also be used to monitor serum electrolytes, particularly K +
which may be decreased. Chest X-ray is helpful in excluding differentials such as inhalation of a
foreign body, pneumothorax, pulmonary oedema, and acute exacerbation of COPD.
• If initial measures fail, add magnesium sulphate 1.2–2 g IV over 20 minutes and give salbutamol
nebulisers every 15 minutes.
• Continue monitoring the patient at regular intervals. If he is still not improving, consider aminophylline
IV. Discuss with your seniors and with the ITU registrar. e sevearity of the attack crying out brief physical
examition including abcs

Pnemonics

Oshitme

O:oxgen

S:salbutomol

H:hydrocortisone

I:ipatropium

T:theophyline

M:magniseum

E:escalate care{intubation and ventilation

Pediatric dosing