CCS ASTHMA

• HPI 5yo child with acute asthmatic attack

Note

• vital signs: BP, Pulse, Resp. Rate, Temp.
• Step I : Emergent management: A, B, C, D- O2 , broncodilaters MDI or nebulizer, depending on severity consider systemic corticosteroids.
• Step II : Physical Examination General appearance, HEET/Neck, Chest/Lung, Heart/CV

Investigations

• Step III : Diagnostic Investigations:
• 1. O2 sat.2
• . PEF
• 3. CBC
• 4. Chem 7
• 5. CXR
• 6. ABG- should be considered in severe distress of when FEV1 <30% of predicted values after initial treatment.

Treatment

1. O22. Beta 2 agonist with MDI or Nebulizer every 20 mins 3. methylprednisolone IV q6h for first 24-48 hours then inhaled steroids Step IV: Decision about changing patients location Discharge home if symptoms resolve quickly or FEV1 is greater than 70% of predicted or personal best.

Recommendations for hospitalization

• 1. response to treatment is poor
• 2. recent hospitalization for asthma
• 3. failure of aggressive outpatient management
• 4. previous life- threatening attack.
• 5. If PEF or FEV1 is less than 50%
• 6. arterial carbon dioxide tension is greater than 42
• 7. If patient is confused of drowsy8. If no easy access to ER

If patient is discharge need to return to office within 5-7 days for follow up. Step V: Educate patient and family:Instruct patient/family to avoid factors that aggravate patients disease.Instruct on proper use of MDI

Diagnosis

STEP VI: Final Diagnosis.Acute asthma attack

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