1. Asthma
ED Junior Teaching

2. Overview: What is asthma? What should you do at assessment?
Classification?
Who to worry about?
Treatment options?
Summary

3. What is asthma?
Airway hypersensitive….that is reversible – essentially esinophillia.
It causes bronchospasm, airway oedema, mucous secretions and occasionally mucal plugging.

4. Signs and symptoms? Wheeze. Shortness of breath. Coughing.
Chest tightness.
Pain.
Sputum production – often clear.
Inability to speak in sentences.
Diurnal variation and episodic in nature.

5. Make an assessment? General examination.
Document SpO2 and oxygen use (put on venturi if possible and document O2 percentage).
Document ability to speak.
Document capillary refill ideally centrally and peripherally.
Document all OBS (RR, GCS, HR, BP, Temp.)
Document PEF and ideally their normal PEF – if they are breathing their last then it may not be appropriate.
Document pre-hospital medications.

6. Classify the severity?

7. Who to worry about?
High CO2 in context of continuing asthmatic wheeze.
Consider sepsis? Are they hot? Are they hypotensive?
Poor colour?
Tripoding?
Silent chest?
Tiring? Unable to speak?
Those patients that have been in ITU previously usually brittle asthma (type 2).

8. ABG or VBG? Depends on clinical situation.
If patient is in extremis consider an ABG.
Only helpful in a small proportion of patients.
Lactate maybe raised due to salbutamol.
Check with your senior.

9. Treatment options?
Salbutamol MDI are the first options – most patients have tried and failed this step.
Salbutamol Nebuliser 5mg via 6lt O2
Ipratropium Nebuliser 500mcg via 6lt O2 (max 4, careful in cardiac disease)
Prednisolone 40mg Oral or Hydrocortisone mg IV
Back to back nebulisers.
Still wheezy ? Early senior input.
Escalate treatment – MgSO4, IV Salbutamol, IV Aminophylline, Nebulised Adrenaline, IV Adrenaline, Ketamine, Intubation…. (not without senior team input).

10. Summary ASTHMA KILLS!! DO NOT UNDERESTIMATE IT!!
Simple things will fix most situations.
Get a senior to review the patient if you are worried.
If a patient is getting worse despite treatment it should worry you…