Hospital Based Care of Asthma
Management of Asthma Attacks :
Hospital-Based Care
Initial Assessment:
History, Physical examination (auscultation, use of accessory muscles, heart rate, respiratory rate) and Investigations (PEF or FEV1, Oxygen saturation SaO2, arterial blood gas analysis and other tests)
Initial Treatment:
- Inhaled short-acting b2-agonist, usually by nebulization, one dose every 20 minutes for 1 hour
- Oxygen to achieve O2 saturation >90% (95% in children)
- Systemic corticosteroids
- Sedation is contraindicated in the treatment of attacks. PFT, PEFR, SaO2 and other tests as needed
Repeat Assessment:
PET,PERF,SaO2 and other tests as needed
Moderate episode
Severe episode
On assessment
• PEFR 50-80% predicted/personal best
• Physical exam: moderate symptoms, accessory muscle use
On assessment
• PEFR - < 50% of predicted value/personal best
• Physical exam: severe symptoms at rest, chest retraction
• High-risk patient
• No improvement after initial treatment
Treatment
• Inhaled b2-agonist every 60 minutes
• Consider corticosteroids
• Continue treatment 1-3 hours, provided there is improvement
Treatment
• Inhaled b2-agonist, hourly or continuous + inhaled anticholinergic
• Oxygen - 40% (5 Lit/min)
• Systemic corticosteroid
• Consider subcutaneous, intramuscular, or intravenous b2-agonist
Good Response Incomplete Response Poor Response
Response within 1-2 Hours Within 1 hour
On assessment • Response sustained 60 minutes after last treatment • Physical exam: normal • PEFR >70% • No distress • O2 saturation >90% (95% children) On assessment • High risk patient • Physical exam: mild to moderate symptoms • PEFR >50% but • O2 saturation not improving On assessment • High risk patient • Physical exam: symptoms severe, drowsiness, confusion • PEFR <50% • PCO2 >45 mm of Hg • PO2 <60 mm of Hg • O2 saturation <90%
Discharge Home • Continue treatment with inhaled β2 agonist • Consider , in most cases, corticosteroid tablets or syrup. • Patient education: Take medicine correctly. •Review action plan. • Close medical follow-up Admit to hospital • Inhaled β2 agonist ± inhaled anticholenergic • Systemic cortic- steroid • Oxygen • Consider intravenous Aminophylline. • Monitor PERF,O2 saturation,pule Admit to ICU • Inhaled b2-agonist + anticholinergic • Inhaled corticosteroid •Consider sub-cutaneous, intra-muscular, or intra-venous b2-agonists • Oxygen • Consider intravenous aminophylline • Possible intubation and mechanical ventilation
See Also:
Step Care Management of Asthma
Emergency Management of Asthma
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