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Asthma (ii) - Coggle Diagram
Asthma (ii)
Acute asthma exacerbation
features
wheeze
tachypnoea
tachycardia (good guide to severity)
use of accessory muscles
chest recession
pulsus paradoxus
SOB, if interferes with talking then severe
cyanosis
fatigue + drowsiness
silent chest on auscultation indicates poor gas exchange - emergency as child may be about to arrest
low O2 sats (<92% = severe/life-threatening)
severity can often be underestimated by clinical exam alone
do CXR only if unusual clinical features (e.g. asymm of chest) or signs of severe infection)
blood gases only in life-threatening situations
management
stay calm!
high dose inhaled bronchodilators, steroids + O2
repeat every 20-30min
spacer or neb
short course (2-5d of oral prednisolone expedites recovery)
IV for those who fail to respond adequately to inhaled bronchodilator
salbutamol or aminophylline or MgSO4
monitor ECG + electrolytes
antibiotics only if features of bacterial infection
artificial ventilation if required
Exercise-induced asthma
brought on only by vigorous exercise
SABA taken immediately before exercise usually sufficient
greater protection with LABA + ICS