Asthma

Asthma Movie Intro

Asthma is inflammation of the small airways of the lungs that causes them to be obstructed, and therefore air passes though them less easily.

Symptoms
Difficulty breathing or "shortness of breath", associated with a "tight" feeling. This may be associated with exercise, come on at night, or on exposure to various external stimuli. Audible wheeze is often present. Cough may be the main or only symptom in some children.

General Treatment for Respiratory Distress

Assess the airway and ventilation Administer oxygen Request ALS (for severe respiratory distress) Monitor breathing Do not permit physical activity Place in fowlers or semi-fowlers

Assess for the following

Vital signs Patients ability to speak in sentences

In this case Silence is Not Golden

Assess for the following

Vital signs Patients ability to speak in sentences Accessory muscle use

Assess for the following

Vital signs Patients ability to speak in sentences Accessory muscle use Lung sounds

Normal Bronchovesicular
Normal sounds heard in the periphery of all lung fields.

Normal Bronchial
Normal sounds heard toward the center of the chest over the larger airways.

Wheezes
Musical sounds heard when there is a constriction of the bronchioles.

In general the higher the pitch the tighter the bronchioles. A quiet chest is the worst case scenario

All that wheezes is not asthma

--Chevalier Jackson, MD (1865-1958). Boston Medical Quarterly, 16:86,1965

Other Causes of Wheezing

Aspiration Certain drugs Chronic obstructive pulmonary disease Endobronchial tumors Endotracheal tumors Inhaled irritants Tracheal stenosis Viral tracheobronchitis Vocal cord dysfunction Pulmonary edema (CHF)

Suspect CHF
Elderly Severe hypertension Digoxin, Lasix, K+ Dependent edema Atrial fibrillation Diaphoresis Rales

Crackles (rales)

Assess for the following

Vital signs Patients ability to speak in sentences Accessory muscle use Lung sounds Oxygen saturation

Record SpO2
> 95% is normal 88-95% mild hypoxia 84-88% moderate hypoxia < 84% severe hypoxia Inaccurate readings
Poor peripheral circulation Nail polish Bright light Toxins (CO, nitrates)

For patients age 1 to 65 with an attack of previously diagnosed asthma

Albuterol may be indicated

Assess for the following

Vital signs Patients ability to speak in sentences Accessory muscle use Lung sounds Oxygen saturation Assessment of severity
Peak flow, Borg scale

Borg Scale
SCALE 0 0.5 1 2 3 4 5 6 7 8 9 10 Very Very Severe (Almost Maximum) Maximum Very Severe Breathlessness SEVERITY No Breathlessness* At All Very Very Slight (Just Noticeable) Very Slight Slight Breathlessness Moderate Some What Severe Severe Breathlessness

Begin transport Administer Albuterol, 2.5 mg/3cc Normal saline via nebulizer. Do not

delay transport to complete medication administration.

Albuterol
Sympathetic Drug Selective 2 agonist Bronchodilator Minimal cardiovascular effects

Indications
Relief of bronchospasm

Cautions
Patients with pertinent cardiac history

Contact medical control first if there is a history of:

Angina Myocardial infarction Arrhythmia Congestive heart failure

Contraindications
Known hypersensitivity to drug

Five Rights of Drug Administration

1. 2. 3. 4. 5. Time Patient Drug Dose Route Exacerbation of asthma 1 65 yrs, Hx of asthma Albuterol 2.5 mg/3ml dilution Nebulizer

Before using any drug

Checklist
Correct medication and dose Color Expiration date

Some patients have home nebulizers

Gather supplies needed, including: medication nebulizer set (nebulizer cup, mouthpiece or mask, tubing Put the medication into the nebulizer cup and screw the cap on securely. Connect the other end of the tubing to the nebulizer cup. Connect the mouthpiece or face mask to the nebulizer cup. Connect the tubing to the oxygen regulator. Set oxygen flow to 6-10 liters Check to make sure a fine mist of medication is coming through the face mask or mouthpiece.

Mouthpiece:
o Place the mouthpiece in the patients mouth with the lips sealed around the mouthpiece. o Encourage your patient to take slow deep breaths in and out of their mouth. The mist should disappear with each breath.

Encourage your patient to continue slow, deep breaths until all the medication in the nebulizer cup is gone. You may need to tap the sides of the nebulizer cup to ensure all medication is given.

Face mask:
o Place the mask over your patients mouth and nose. The adjustable elastic band may be used to hold the mask in place. o Encourage your patient to take deep breaths in and out for the duration of the treatment.

 If symptoms persist, treatment may be repeated once, after 10 minutes, for a total of two (2) doses Reassess patient after each treatment and prior to transfer of care

Report treatment and response to ED staff