RESPIRATORY
RESPIRATORY
Embedded Files
ASTHMA
ASTHMA
ABOUT THIS SESSION
ABOUT THIS SESSION
This is a self-directed learning resource designed to be worked through in the clinical environment.
Learning objectives:
Learning objectives:
Take a focused history from a patient presenting with probable exacerbation of asthma and consider appropriate differential diagnoses
Suggest and interpret results of relevant investigations for an acute exacerbation of asthma
Understand the management of an acute exacerbation of asthma, including risk stratification and levels of care
Total time:
45 minNumber of students:
1-2Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Kit TigwellUploaded:
14th September 2019Last updated:
14th September 2019Resources needed for this session:
Resources needed for this session:
Pen, paper, peak flow meter
Resources linked to this session:
Resources linked to this session:
None
Activity 1: History Taking and Examination Skills
15 minActivity 1: History Taking and Examination Skills
Take a focused history from the patient (try limiting yourself to a maximum of 15 minutes), to include past medical history, drug history, family history and social history.
Explore their diagnosis of asthma in more depth, e.g.
How is it currently managed? What is their compliance with treatment like?
How frequently do they exacerbate? How severely? Have they ever been admitted before?
What is their inhaler technique like?
What are their triggers to exacerbating?
Activity 2: Documentation
5 minActivity 2: Documentation
Document your history and examination on a clerking proforma or continuation sheet.
Consider:
Suggest three differential diagnoses (other than asthma) for your patient's symptoms.
What investigations would be useful acutely to confirm your diagnoses and exclude alternatives? What might you expect them to show?
Activity 3: Assessment of Severity
5 minActivity 3: Assessment of Severity
Assist the patient to perform a series of peak flow readings - use the best of three. Using the patient's best ever reading, or a predicted value from an online calculator, calculate the peak flow percentage reduction.
What does this tell you about the severity of an acute asthma exacerbation?
What other clinical features determine the severity of an asthma attack? Suggest five.
Review the patient's notes to assess the severity of this patient's asthma attack.
Activity 4: Investigations
5. minActivity 4: Investigations
Review the patient's initial blood gas (from admission). If none is available, use the examples opposite. Consider the ABG findings and answer the questions below:
Example 1:
Is there a pH disturbance?
Is it likely to be metabolic or respiratory driven?
What pathological process is driving this?
What can the ABG tell you about the severity of the exacerbation?
ABG on 60% oxygen
pH 7.49
pCO2 3.3kPa
pO2 41.1kPa
HCO3 25mmol.l
Example 2:
Is there a pH disturbance?
Is it likely to be metabolic or respiratory driven?
What pathological process is driving this?
What can the ABG tell you about the severity of the exacerbation?
How would your management change in this case, compared to the example above?
ABG on 100% oxygen
pH 7.21
pCO2 6.6kPa
pO2 20.5
HCO3 26
Activity 5: Interpreting Basic Imaging
5 minActivity 5: Interpreting Basic Imaging
Review the patient’s chest radiograph. If none is available, use the examples below. Using a systematic approach, assess for any abnormalities.
Example 1:
Example 2:
Activity 6: Prescribing
5 minActivity 6: Prescribing
Using a drug chart, prescribe appropriate initial management for acute severe asthma, including oxygen, bronchodilators and steroids. Use a BNF if needed.
Activity 7: Further Management
5 minActivity 7: Further Management
Review some local or national guidelines for the management of asthma e.g. the BTS/SIGN 2019 Asthma guidelines here.
Consider the following points:
Where is this patient best managed?
What criteria should be met prior to discharging this patient following an acute exacerbation?
What follow up should be arranged on discharge?
Summary and Feedback
5 minSummary and Feedback
Highlight three key things you have learned today. Summarise them on a post-it note and keep it somewhere you will find in a week or two.
Found this useful? Please leave some feedback.
References and Further Reading
References and Further Reading
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