Management of acute airways disease

1
Management of acute airways disease

• Dr Peter Wark
• Associate Professor Department of Respiratory and
  Sleep Medicine
• John Hunter Hospital

2
Case Miss JK

• 18 year old college student
• Presents to the emergency room
• Breathless
• Very distressed having difficulty speaking
• Complaining of chest tightness
• On arrival
• Pulse 120
• RR 45
• SaO2 90

3
Treat

• Give high flow oxygen
• If you consider asthma possible treat acutely
  with short acting bronchodilators

4
What do you do?

• Take a history and examine
• Investigate
• ABGs
• CXR

5
Diagnosis

• More settled on oxygen and following salbutamol
  400mcg
• SaO2 94
• Can you confirm the diagnosis?
• Cause of acute asthma?

6
Treatment
7
Short acting beta agonists

• Delivery of salbutamol?
• Nebulised salbutamol
• Puffer and spacer

8
Corticosteroids for acute asthma

• Commence parenteral corticosteroids
• Commence inhaled corticosteroids

9

• Start treatment with salbutamol 5mg neb 4hrly
  Prednisone 25mg
• Called to see patient on ward
• More breathless
• Not relieved by salbutamol nebs x2
• Pulse 130
• ABGs
• pH 7.224
• PaO2 88mmHg
• PaCO2 45mmHg
• HCO3 18mmols

10
Treatment

• Commence continuous inhaled salbutamol
• Add Ipratropium bromide
• Commence IV salbutamol
• Commence IV aminophylline
• Commence IV magnesium