RESPIRATORY
RESPIRATORY
Embedded Files
ASTHMA
ASTHMA
Introduction
5 minIntroduction
Introduce yourself and the group
Provide rationale for the session and relevance to clinical practice
Outline learning objectives:
- Take a focussed 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
Explain structure of session
Total time:
45 minNumber of students:
1-5Grade 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
Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.
Resources linked to this session:
Resources linked to this session:
Activity 1: History Taking and Examination Skills
20 minActivity 1: History Taking and Examination Skills
Ask student(s) to take a focussed history from the patient (maximum 10 minutes), to include past medical history, drug history, family history and social history. This can be observed if capacity of tutors allows.
Activity 2: Diagnostic Reasoning
5 minActivity 2: Diagnostic Reasoning
Discussion and feedback.
Present the key findings of the case, Consider:
- What differential diagnoses have you considered and why are these less likely?
- What investigations would be useful acutely and what are you expecting them to show?
- How would you clinically assess the severity of an acute asthma exacerbation and, accordingly, what would be your initial management?
Feedback on history taking style & presentation (max 1 minute).
Activity 3: Bedside Tests
5 minActivity 3: Bedside Tests
Ask the student(s) to assist the patient to perform a peak flow reading. Use the best of three readings. Ask the students to calculate the patient's predicted peak flow (PEF) value using an online calculator or trust guideline. The QR opposite links to an online calculator.
Discuss the PEF findings using the questions below as prompts:
- Is this patient’s PEF reduced? If so, how would you quantify it?
- What can PEF tell you about the severity of the exacerbation?
Activity 4: Investigations
5. minActivity 4: Investigations
Allow the student(s) to review the patients blood gas. If none is available, use the examples opposite. Discuss the ABG findings using the questions below as prompts.
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-1
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 7.6
pO2 20.5
HCO3 25
Activity 5: Interpreting Basic Imaging
5 minActivity 5: Interpreting Basic Imaging
Allow the students to view the patient’s chest radiograph. If none is available, use the examples below. Ask the students to systematically interpret the radipgraph.
Example 1: (note this is normal)
Example 2: (hyperinflation)
Discuss the common x-ray findings in acute exacerbation of asthma.
Activity 6: Prescribing
5 minActivity 6: Prescribing
Ask the students to use a drug chart to prescribe appropriate initial management for acute severe asthma, to include oxygen, bronchodilators and steroids. They can use a BNF if needed.
Activity 7: Further Management
5 minActivity 7: Further Management
Ask the student(s) to find local or national guidelines for the management of asthma. The QR code opposite links to the BTS/SIGN 2019 Asthma Guidelines.
Discuss the following points:
- Does your patient need to be admitted to hospital?
- If so, how would you decide the most appropriate team to refer to/place for ongoing care?
- What criteria should be met prior to discharge following an acute exacerbation?
- What follow up should be arranged?
Summary and Feedback
5 minSummary and Feedback
Questions
Identify and summarise key learning points (key three points if possible)
Feedback to student – highlight further learning needs
Feedback for teacher - ask students to provide feedback using the QR code opposite
Close
References and Further Reading
References and Further Reading
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