Asthma

Question 1

What are further questions to ask with regards to asthma

Answer 1

1. Any asthma medications
2. Frequency of medication use
3. Frequency of asthma attack
4. How severe is the attack - any need for hospitalization or intubation
5. Whats the aggravating factor
6. Any hx of status asthmaticus
7. Last attack?
8. How does ptn controls/monitors asthma (any usage of PEF meter) - usually to see any changes in FEV1

Question 2

Types of asthma meds

Answer 2

B2 agonist (short acting - SABA) - Salbutamol/albuterol
Low dose steroid inhaler - budesonide/fluticasone
LABA - Salmametrol
Oral/IV steroid
Anticholinergic - Ipatropium
Leukotriene modifier - Montelukast
Lipoxygenase

Emergency meds:
IV steroids
SABA nebulizer
Ipatropium

Question 3

Give drugs that may induce asthma

Answer 3

NSAIDS
Aspirin
Beta blockers
ACE inhibitors
Strong opioids (morphine/tramal)

Question 4

What are safe analgesias for asthma patients

Answer 4

Acetaminophen
Weak opioids (codeine)

Question 5

What are lab tests to check compliance to see well or poorly controlled asthma

Answer 5

Pulmonary function test

PEFR (FEV1)

Question 6

Preop mx of asthma patients

Answer 6

1. Ausculation to look signs of obstruction - wheezing/stridor
2. CXR only necessary if poorly controlled asthma
3. 2-3 puffs of ptns inhaler
4. +/- oral steroid for control

Question 7

What is tx when ptn has Asthma attack during surgery

Answer 7

1. Recognize symptoms and signs (diaphoretic, agitated, tachycardic, tachypneic, use of accessory muscles, trachela tugging, reduce spo2) -> alert EMS
2. 2-3 puffs of SABA inhaler
3. 2-3 puffs of Ipatropium
4. 100% oxygen full face mask
5. SC 0.5mg epinephrine 1:1000
6. Positive airway pressure
7. IV diphenhydramine 50mg, IV dexa 20mg (if suspect allergy)
8. Intubation prn

Question 8

What is possible complication of intubation in asthmatic

Answer 8

Pneumothorax

Tension pneumothorax

Question 9

Periop mx of asthma ptns

Answer 9

1. Risk stratification
   - pts understanding and compliance
   - assess control by history and PEFR (FEV1)
   - elective surgery contraindicated in poorly controlled
2. Intraop
   - adequate oxygenation
   - avoid excessive airway stimulation (use throatpacks and suctioning)
   - IV lidocaine prior to extubation can reduce airway stimulation
3. If bronchospasm
   - assess vital signs
   - 100% oxygen supplemental
   - inhaled SABA
   - inhaled other bronchodilator (ipatropium)
   - IV sympathomimetic (epinephrine) and steroid
   - ventilatory support