Dr Edwin Chau & Dr Saarth Shiralkar Calderdale & Huddersfield NHS Trust
Objectives
Epidemiology Investigations Management Acute severe asthma Acute exacerbation of COPD
Asthma
Chronic disease characterised by recurrent attacks of SOB and wheeze Varying severity and frequency Bronchial muscle contraction airway narrowing Mucosal swelling and inflammation release of inflammatory mediators airway wall thickening
Asthma - Investigations
Peak flow Spirometry Chest x-ray Skin prick test Aspergillus antibodies Histamine/methacholine challenge
Asthma Management
COPD
Persistent blockage of airflow from the lungs Umbrella term for emphysema and chronic bronchitis FEV1 <80% of predicted FEV1:FVC ratio <70% of predicted
COPD Investigations
FBC CXR ABG ECG Lung functions
COPD Management
Common
Persistent, progressive Uncommon Not with significant disease
Uncommon
Variable Common Probably
Anaphylaxis
Severe, life threatening Type 1 IgE mediated hypersensitivity reaction Caused by foreign substance
Anaphylaxis Management
ABCDE approach Adrenaline 0.5mg 1:1000 IM Remove/treat underlying cause Chlorphenamine 10mg IV Hydrocortisone 200mg IV Salbutamol 5mg nebs May need ICU admission
Scenario 1
A 7 year old girl has had poor control of asthma for the past 6 months. She has been using 2 agonist inhaler (with spacer) alone. How would you modify her treatment? a) Add a steroid inhaler b) Add a ipratropium bromide inhaler c) Add a salbutamol turboinhaler d) Add an oral steroid
Scenario 1
A 7 year old girl has had poor control of asthma for the past 6 months. She has been using 2 agonist inhaler (with spacer) alone. How would you modify her treatment? a) Add a steroid inhaler b) Add a ipratropium bromide inhaler c) Add a salbutamol turboinhaler d) Add an oral steroid
Scenario 2
A 25 year old asthmatic male is visiting your town for the weekend. His asthma in the past week has been poor and he has had to use his salbutamol inhaler 3 times daily. On examination his peak flow is 70%. As a GP what do you do? a) Tell him to wait to see his own GP b) Prescribe more salbutamol inhalers c) Prescribe steroid and salbutamol inhalers d) Prescribe oral steroids
Scenario 2
A 25 year old asthmatic male is visiting your town for the weekend. His asthma in the past week has been poor and he has had to use his salbutamol inhaler 3 times daily. On examination his peak flow is 70%. As a GP what do you do? a) Tell him to wait to see his own GP b) Prescribe more salbutamol inhalers c) Prescribe steroid and salbutamol inhalers d) Prescribe oral steroids
Scenario 3
A patient with respiratory problems presents to A&E. You suspect COPD. The nurse has put in an IV cannula and taken bloods. What is the next investigation? a) Chest x-ray b) Skin prick test c) ABG d) Sputum culture
Scenario 3
A patient with respiratory problems presents to A&E. You suspect COPD. The nurse has put in an IV cannula and taken bloods. What is the next investigation? a) Chest x-ray b) Skin prick test c) ABG d) Sputum culture
Scenario 4
A patient with COPD presents to A&E. His blood gases show SpO2 = 6 and SpCO2 = 7. He is started on 60% FiO2. His next blood gas shows SpO2 = 14 and SpO2 = 8. What would be the next appropriate action? a) Mechanical ventilation b) Give combined O2 and CO2 c) Decrease FiO2 d) Request a nurse to monitor him
Scenario 4
A patient with COPD presents to A&E. His blood gases show SpO2 = 6 and SpCO2 = 7. He is started on 60% FiO2. His next blood gas shows SpO2 = 14 and SpCO2 = 8. What would be the next appropriate action? a) Mechanical ventilation b) Give combined O2 and CO2 c) Decrease FiO2 d) Request a nurse to monitor him
Scenario 5
A 50 year old male presents to A&E with a severe adverse reaction to a wasp sting. What would be your initial management? a) Pour vinegar on the sting b) Give chlorphenamine 10mg IV c) Secure the airway d) Transfer the patient to ICU
Scenario 5
A 50 year old male presents to A&E with a severe adverse reaction to a wasp sting. What would be your initial management? a) Pour vinegar on the sting b) Give chlorphenamine 10mg IV c) Secure the airway d) Transfer the patient to ICU
Summary
Asthma tends to be a disease of the young COPD tends to be a disease of middle age Learn NICE & BTS guidelines for long term management Always use ABCDE approach for acute illness Memorise doses for acute drugs
Any Questions?