Professional Documents
Culture Documents
Definitions:
Chronic inflammatory disorder of the airways in which
• many cells and cellular elements play a role.
• In susceptible individuals, this inflammation causes
recurrent episodes of wheezing, breathlessness, chest
tightness, and coughing, particularly at night or in the
early morning.
• These episodes are associated with widespread but
variable airflow obstruction that is reversible either
spontaneously, or with treatment.
• Usually associated with airflow obstruction of
variable severity.
• Airflow obstruction is usually reversible, either
spontaneously, or with treatment
• The inflammation associated with asthma
causes an increase in the baseline bronchial
hyper responsiveness to a variety of stimuli
Classification
• Extrinsic – implying a definite external cause
more frequently in atopic individuals
(atopic – individual which tends to develop
hypersensitivity by contact with allergens)
often starts in childhood - accompanied by
eczema
Eg. Dust mites, mold spores, animal dander,
cockroaches, pollen, indoor and outdoor
pollutants, irritants (smoke, perfumes, cleaning
agents)
• Intrinsic/ Late onset
no causative agent can be identified
starts in middle age
Eg. Pharmacologic agents (ASA, beta-blockers)
Physical triggers (exercise, cold air)
Physiologic factors
Stress, viral and bacterial URI, rhinitis
Clinical signs
• Feeling of chest tightness
• Dyspnea
• Non productive cough
• wheeze
severe imminent failure
• Breathlessness-
• On lying down
• Speaking-Words cannot speak
• Level of consciousness- confused
Always agitated
• Breathing rate->30/min
• Muscle retraction- Usually paradoxical
movements
• Wheezing- Very strong absent
• Pulse/minute->120 bradycardia
Goal of asthma treatment
• Prevent and treat acute episodes of asthma
• Control chronic and nocturnal symptoms
• Maintain normal activity, including exercise
• Minimize ER visits and hospitalizations
• Minimize need for reliever medications
• Maintain near-normal pulmonary function
• Avoid adverse effects of asthma medications
Managing acute exacerbation of asthma
Main aim is to
• Relieve airflow obstruction
• Hypoxemia as quickly as possible, and to plan prevention
of future relapses.
• Oxygen administration to maintain SpO2 >90%
• Inhaled Salbutamol/Terbutaline preferably by nebulizer
• with spacer with/without facemask
• 1-2 puffs every 2-4 minutes upto 10 puffs and repeat
every 20-30 minutes
3. Ipratropium Bromide 250 mcg by nebulizer
with Salbutamol
4. Inj. Hydrocortisone 10mg/kg IV
5. Inj. Aminophylline 5 mg/kg bolus slowly
followed by
0.8-1.2 mg/kg/hr slow infusion
6. Inj. Magnesium sulphate 40mg/kg in 50 ml 5%
dextrose as slow infusion over 30 minutes
Two major group of drugs
• Bronchodilator drugs to relieve bronchospasm
and improve symptoms.
• Anti inflammatory drugs to treat the airway
inflammation and bronchial
hyperresponsiveness, the underlying cause of
asthma, i.e. to prevent attacks.
• Monitoring the effects of treatment
Repeat Puff 15-30min after initiating treatment
Pulse oximeter monitoring: maintain SaO2 >92 %.
Check blood gases within 2h if: initial PaO2 was
normal
raised or initial PaO2 <8 kPa (60mmHg) or patient
deteriorate
Pneumothorax
• Pneumothorax-
is Air in pleural cavity
• Etiology-
traumatic and non traumatic causes
• Tension and open neumothorax
• S/S :
V/S changes
• Tachypnea , dyspnea, SOB, Tachycardia, decrease of CO &
BP
Cyanosis
Hyper resonant note
Diminished breath sounds
Tracheal shift
Displaced heart sounds
Increased thoracic volume on the affected side
Emergency management
Cause Treatment
• CNS depression------Reverse opioids- naloxon
other causes – ventilate
• Muscle paralysis-------------------Ventilate
• Pleural space collection-----intercostals drain
• Flail chest---------------------------Analgesia,
physiotherapy, ventilate if large
Obstructive airway
• Upper airway----------clear airway, correct
position, intubation, tracheostomy
• Foreign body--------suction, physiotherapy,
Drainage and bronchoscopy
• Bronchospasm--------Nebulise, salbutamol,
Aminophyline & hydrocortisone
Inadequate gas exchange