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26 Cards in this Set
- Front
- Back
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How do you diagnose acute asthma exacerbation in children? |
In children, there is no single best tool for assessing severity of exacerbation, monitoring response to treatment or predicting need for hospitalization. Diagnosis in infants should rely on physical exam findings rather than FEV1. |
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What are initial treatments for acute asthma exacerbations? |
Initial treatment should include: - oxygen - short-acting beta-agonist (SABA) for all patients;
- ipratropium bromide, especially for moderate to severe exacerbations; and - systemic corticosteroids for most patients |
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______ is a better predictor of need for hospitalization than severity of the attack on presentation. |
Response to initial treatment in the ED |
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Asthma is the most common potentially serious complication in _______. |
pregnancy |
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What are causes of acute asthma? |
* Allergen exposure in sensitized individuals.
* Viral infections. * Exercise. * Irritants. * NSAIDs. * Tobacco smoke. * Gastroesophageal reflux disease. * Use of antibiotics in the first year of life is associated with later development of asthma. 6 * Young children with atopic eczema are at increased risk of asthma - approximately one-third will develop it after the age of 6 years. |
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Asthma exacerbations have 2 phases: |
Exacerbations have 2 phases: Early allergen response (EAR) and the late allergen response (LAR). |
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Bronchospasm of the EAR involves ______ |
release of leukotrienes LTC4, LTD4, LTE4. |
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Late allergen response: |
then produce a TH2 induced LAR about 4 hours after the initial trigger that will usually persist 12-24 hours, but in some children may persist for several days. |
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What are risk factors to asthma exacerbation? |
Indoor allergy and exposure Smoking URI in the last month Lower asthma knowledge Medication non-adherence |
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A ____ prior to exercise remains the mainstay of therapy for exercise-induced asthma, to prevent symptoms |
short-acting beta agonist (SABA) |
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Acute exacerbation is divided into 3 levels: |
Asthma exacerbations are divided into three categories: mild, moderate, and severe |
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Mild asthma exacerbation: |
initial FEV1 greater than or equal to 200 L/min or greater than or equal to 70% of predicted best. |
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Moderate asthma exacerbation: |
initial FEV1 80 to 200 L/min or 40-69% of predicted best |
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Severe asthma exacerbation: |
initial FEV1 less than or equal to 80 L/min or less than or equal to 40% of predicted best. |
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Lifethreatening asthma exacerbation: |
a sub-set of severe, with an initial FEV1 of less than 25% of predicted best. |
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When should CXR be obtained? |
A CXR should be ordered only in those patients with evidence of complications such as leukocytosis, hypoxemia, unexplained chest pain, or temperature >38.3°C |
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When are ABG testing indicated? |
ABG testing is indicated in patients with persistent dyspnea despite bronchodilator therapy who have a peak expiratory flow below 25 percent of normal |
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A PEFR below _____ is an indication of severe obstruction. |
200 L/min |
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True/false: Pulmonary function tests with spirometry and flow volume loops is typically in the non-decompensated state |
true |
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For severe exacerbations that do not respond to initial treatment consider ____ |
IV magnesium or heliox |
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Systemic corticosteroids should be given and continued unil FEV1 returns to ____ of predicted or personal best |
>70% |
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Continue treatment with ____ after release from ED/hospital. |
inhaled SABA |
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Patient should be instructed to call physician if using____in 24 hours |
>12 puffs |
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Preferred short acting BA in pregnancy: |
albuterol |
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Preferred ICS in pregnancy: |
budenoside |
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Oxygen saturation (SaO2) <___ indicates serious distress. |
90% |
