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BY: Shazlin Bt. Sabaah Salwa Hanim Bt. Mohd. Saifuddin Kamarulzaman B. Muzaini
BY: Shazlin Bt. Sabaah Salwa Hanim Bt. Mohd. Saifuddin Kamarulzaman B. Muzaini
BY: Shazlin Bt. Sabaah Salwa Hanim Bt. Mohd. Saifuddin Kamarulzaman B. Muzaini
No known allergies
BIRTH Hx
1 month √
2 months √ √ √
3 months √ √ √
5 months √ √ √
6 months √
12 months √
18 months √ √ √
6 years √
DEVELOPMENTAL Hx
Impression:
Impression:
Oral cavity:
No gum bleeding
No ulcers
No central cyanosis
Extremities:
Warm peripheries
No clubbing of fingers
No palmar erythema
No peripheral oedema
No koilonychias.
The chest was barrel shape. There was no scar on the chest wall and no
dilated veins. There were suprasternal and subcostal recession. The chest
moved symmetrically with respiration.
• Palpation:
The trachea was centrally located. The chest expansion was symmetrical
bilaterally. The apex beat was palpable at 5th intercostals within
midclavicular line. Vocal fremitus was equal bilaterally.
• Percussion:
Resonance bilaterally.
Auscultation:
Impression:
• Palpation:
Apex beat was palpable at the 5th intercostals space lateral to midclavicular
line. There was no thrill or heave.
• Auscultation:
The first and second heart sounds were heard with normal intensity and
frequency. There was no additional heart murmur detected.
Palpation:
The abdomen was soft and non-tender. There was no hepatosplenomegaly. Both kidneys
were not ballotable.
Percussion:
The abdomen was tympanic. There was negative shifting dullness and no fluid thrills.
Auscultation:
Normal bowel sound present.
Motor system
Inspection:
The upper and lower limbs were symmetrical. There was no muscle
wasting, abnormal movement or posture, or gross deformity. The skin was
normal and there was no surgical scar or fasciculation seen. The muscle
bulk was equal bilaterally and not wasted.
Muscle tone: The muscle tone of the upper and lower limbs was normal.
Muscle power: The power of all muscles tested in the upper and lower limbs
was normal, with grade 5/5.
Reflexes: The reflexes of upper and lower limbs were present with normal
intensity. Babinski reflex was negative.
Coordination: The coordination of the upper and lower limbs was normal.
Gait: Normal.
was admitted due to fever and cough one day prior to admission, shortness
Points to support:
Known case of asthma since 2years ago
MH developed shortness of breath and rapid breathing that was
exacerbated by cough
Vesicular breath sound with prolong expiration
Suprasternal and subcostal recession
Ronchi was heard on the upper zone during expiration bilaterally
Differential Diagnosis Points to support Points to against
Impression: Normal
Normal
ED:
Salbutamol Nebulizer –cont 1hour
Oxygen mask
IV hydrocortisone
Ipratropium bromide: 4hourly
IV fluid-maintainance
Blood investigation: FBC, VBG, electrolyte
If not, IV salbutamol or aminophyline
If the symptoms persist, intubation.
At home:
Avoid allergens
syrup prednisolone
MDI Salbutamol
DISCUSSION OF ASTHMA
Respiratory infections
Bronchial inflamation
Airways narrowing
Symptoms:
-cough
-wheezing
-breathlessness
-chest tightness
CLINICAL FEATURES
•Cough
•Chest tightness
•Wheezing sound of breath
•Episodic shortness of
breath
•Worsen during night
Various severities of asthma
Classification of asthma severity
- Mild intermittent
- Mild persistent
- Moderate persistent
- Severe persistent
PALPATION
- Decrease symetrically chest wall expansion
PERCUSSION
-resonance
AUSCULTATION
-(reduced breath sound, rhonci, vesicular breath sound with
prolong expiration time)
INVESTIGATION
3)Chest X-ray.
Helpful in excluding a pneumothorax
/ pneumonia.
Criteria for admission
1. failure to respond to standard home
treatment
2. Failure of those with mild or moderate
acute asthma to respond to nebulised B2-
agonist.
3. Relapse within 4 hours of nebulised B2-
agonist.
4. Severe acute asthma
STATUS ASTHMATICUS
-Is an acute exacerbation of asthma attack
which do not respond adequately to
therapeutic measures and required
hospitalization
Thank you