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Asthma Emergency Guide for Schools Pediatric Asthma Emergencies Asthma Exacerbation Management in the ER Asthma Inpatient Management What precautions should you take if you know a patient has asthma? How would you manage an acute asthma exacerbation (attack)? What happens to the lungs during an asthma attack? Does a patient with asthma show symptoms in between exacerbations? The signs and symptoms of an asthma attack can be variable. List them. What precautions should you take if you know a patient has asthma? How would you manage an acute asthma exacerbation (attack)? What happens to the lungs during an asthma attack? The airways (bronchi) of the lungs are (reversibly) narrowed during an attack (or “acute exacerbation”). During an attack, the muscle cells in the bronchi constrict, with the airways becoming swollen and inflamed. Does a patient with asthma show symptoms in between exacerbations? Usually very few, or none. The signs and symptoms of an asthma attack can be variable. List them. There is great variation in symptoms, from occasional mild attacks (brought on by a trigger) to severe cases where breathing is chronically obstructed. Symptoms include shortness of breath, tight chest, and wheezing when breathing out. Sometimes there is repeated coughing. The neck muscles may become visible as the patient struggles to breathe. If the attack is very severe, the patient may turn blue, or even lose consciousness. What precautions should you take if you know a patient has asthma? Ensure the emergency drug kit contains Salbutamol aerosol inhaler (100 micrograms / actuation). Ensure that emergency oxygen is available. How would you manage an acute asthma exacerbation (attack)? Interventions and Practices Considered Evaluation 1.Assess signs and symptoms including respiratory symptoms, heart rate, peak expiratory flow (PEF), oxygen saturation, response to treatment, cyanosis, bradycardia, hypotension, exhaustion, confusion, unconsciousness 2.Tests, as indicated, such as arterial blood gas analysis, pulse oximetry, theophylline concentration, electrocardiogram (ECG), chest x-ray, serum haematocrit, potassium and blood glucose. Management/Treatment 1.Place patient in a comfortable sitting position 2.Oxygen 3.Salbutamol aerosol (or fenoterol) and ipratropium bromide 4.Theophylline in select circumstances 5.Corticosteroid 6.Magnesium sulphate 7.Fluids 8.Sedative drugs in select circumstances 9.Beta agonists 10.Intensive care, if needed 11.Post-hospital patient discharge preparation including provision of medications (oral steroid, inhalable anti-inflammatory drug, inhalable beta sympathomimetic drug), instruction in correct inhaler technique, scheduled follow-up appointment. Note: Guideline developers considered but did not recommend patting physiotherapy. They also considered but did not recommend antimicrobial drugs if no signs of bacterial infection are present. Major Outcomes Considered •Pulmonary function (peak flow, forced expiratory volume) •Relapse rates •Hospital admission rates •Effectiveness of treatment •Length of stay in emergency department •Adverse effects of medications Here are further guidelines. |