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1, acute severe asthma (Managment (7. if no improvement consider IV…
1
acute severe asthma
Managment
7.
if no improvement consider IV infusion of magnesium sulphate or salbutamol and ventilation
6.
exclude pneumothorax on CXR
5.
Give IV steroids e.g hydrocortisone 200 mg iv/ 4 hours
4.
add nebulised anti-muscarinics e.g ipratropium bromide 0.5 mg
3.
nebulised ß2 agonist e.g salbutamol 5 mg and repeat if no improvement otherwise 4 hourly
2.
give oxygen 40-60%
1.
reassure pt. and monitor pulse oximetry &arterial blood gases
life threatening features
low and falling arterial pH
very low PaO2 <8kPa despite oxygen
high PaCO2 >6 kPa
peak flow <30% of predicted normal or best
silent chest, cyanosis or feeble respiratory effort
bradycardia or hypotension
exhaustion , confusion or coma
clinical features
peak flow <50% of predicted normal or best
inability to complete a sentence in one breath
tachycardia=110 bpm
respiratory rate=25/min