CPG-03
-
CPG - 03
1/11
PCT
CPG - 03
2/11
o Cardiogenic Conditions : - Congestive Heart Failure, MI
o Pulmonary Conditions : - Pulmonary edema, Foreig...
CPG - 03
3/11
- ---- Wheezing
Chest X-ray : - normal
- Bronchodilator test :- PEFR >
- -
COPD )
Emphysema
Chronic Bronchit...
CPG - 03
4/11
-
Emphysema : - AP
diameter
-
-
-
Chronic Bronchitis :- Peribronchial
thickening
(Bronchiectasis)
-
Chronic ...
CPG - 03
5/11
Chest X-ray :- Peribronchial Thickening
Chronic Bronchitis Lower
lobe
- Honeycomb appearance
1.
2.
3.
1. ER,...
CPG - 03
6/11
3.
1)
2) Care Plan
4.
Asthma
Controllers Relievers
1. Controllers
Persistent
Inhaled Corticosteroids (ICS)
1...
CPG - 03
7/11
--
Hypersensitivity
Side effect Steroids
adrenal
gland Bone mass
- -
-
Long - acting ß2- agonist
Salmeterol ...
CPG - 03
8/11
--
2.1Short-acting ß2- agonist Salbutamol
Inhaler, NB
hypokalemia
- Pregnancy
2.2 Anticholinergic drug + ß2 ...
CPG - 03
9/11
Budesonide
MDI
200 mg/puff 200-1600 mg /
Prednisolone 5 mg 5-60 mg /
0.1-2 mg/kg /
Dexamethasone 4 mg/Amp 5 ...
CPG - 03
10/11
Salbutamol NB Salbutamol
0.5
> 12 0.5-1
cc 4-6 < 12
> 20 0.5 cc
4-6
< 12 < 20 0.25
cc 4-6
Salbutamol 2 mg/ ...
CPG - 03
11/11
Aminophylline 250 mg/ 10 ml 4 mg./kg/dose
8 (
mg)
1.
Asthma, COPD PEF
Bronchodilator Bronchodilator
PEFR
2....
CPG - 03
12/11
Asthma , COPD
Bronchiectasis
2.
Intermittent Persistent
1. ≥ 1
2. ≥ 2
3. PEFR < 80 %
- Persistent
ICS ( ste...
CPG - 03
13/11
3.
4.
5.
Step
ß2- agonist as needed
2. ICS (low dose)
3. ICS (low dose) +
LABA
4. ICS (low dose) +
LABA + X...
CPG - 03
14/11
7. ICS (high dose)
+LABA + Xanthine +
Prednisolone
Budesonide 3 x 2 + Seretide
(25/125) 2 x 2 + Theophyllin...
CPG - 03
15/11
-
- Secretion obstruction
ß2 agonist NB ê O2 6 /min O2
Sat
-
Dexamethasone mg stat Prednisolone
6 Tb stat
-...
CPG - 03
16/11
Retraction
Retraction 1
Retraction > 1
Wheezing
Expiratory wheezing
Inspiratory Expiratory
4.
O2 Sat ≥ 95
-...
CPG - 03
17/11
- Admit Refer
2. Total Score 4-7
Dexamethasone 8 mg v Stat-
Salbutamol NB
Severity Score
o Severity Score <...
CPG - 03
18/11
--
≥ 8 ≤ 7
Bronchodilator
NB Stat
Dexamethasone
8 mg v stat
Bronchodilator
Asthma Severity
Score
CPG - 03
19/11
ADMIT REFER
≥4<4
Discharge
with F/U
Bronchodilat
or 2
≥4
≥ 4
<4
< 4
Discharge
with F/U
Bronchodilat
or 3
≥4...
CPG - 03
20/11
CPG - 03
21/11
CPG - 03
22/11
CPG - 03
23/11
CPG - 03
24/11
CPG - 03
25/11
CPG - 03
26/11
CPG - 03
27/11
CPG - 03
28/11
CPG - 03
29/11
CPG - 03
30/11
CPG - 03
31/11
CPG - 03
32/11
CPG - 03
33/11
CPG - 03
34/11
CPG - 03
35/11
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cpg for asthma

  1. 1. CPG-03 -
  2. 2. CPG - 03 1/11 PCT
  3. 3. CPG - 03 2/11 o Cardiogenic Conditions : - Congestive Heart Failure, MI o Pulmonary Conditions : - Pulmonary edema, Foreign Body, Pneumothorax, Hemothorax, Pleural Effusion, Pulmonary Tuberculosis, Pneumonia o : GERD, Anaphylaxis o Asthma Bronchiectasis COPD (Emphysema + Chronic Bronchitis) (Asthma) Rhinitis, Conjunctivitis Dermatitis -
  4. 4. CPG - 03 3/11 - ---- Wheezing Chest X-ray : - normal - Bronchodilator test :- PEFR > - - COPD ) Emphysema Chronic Bronchitis --- Lungs :- Ronchi, Crepitation Wheezing - Decreased Breath sound - Barrel chest - Chest X-ray
  5. 5. CPG - 03 4/11 - Emphysema : - AP diameter - - - Chronic Bronchitis :- Peribronchial thickening (Bronchiectasis) - Chronic Bronchitis - Lungs :- Ronchi, Crepitation, Wheezing : -- - - -
  6. 6. CPG - 03 5/11 Chest X-ray :- Peribronchial Thickening Chronic Bronchitis Lower lobe - Honeycomb appearance 1. 2. 3. 1. ER, Admit) 2. 3. 4. 5. 1. 1) 2) 3) 4) 2.
  7. 7. CPG - 03 6/11 3. 1) 2) Care Plan 4. Asthma Controllers Relievers 1. Controllers Persistent Inhaled Corticosteroids (ICS) 1.1 Corticosteroids Inflammation mucous - action ß2-against
  8. 8. CPG - 03 7/11 -- Hypersensitivity Side effect Steroids adrenal gland Bone mass - - - Long - acting ß2- agonist Salmeterol Fluticasone ( ICS ) Seretide 2 25/50 25/125 Corticosteroids Inflammation - ICS ICS - Xanthine Sustained release (Thophylline SR) Inflammation 2. Relievers
  9. 9. CPG - 03 8/11 -- 2.1Short-acting ß2- agonist Salbutamol Inhaler, NB hypokalemia - Pregnancy 2.2 Anticholinergic drug + ß2 - agonist Berodual Inhaler NB Ipratropium bromide Fenoterol - - Hypokalemia - Prostate hyperplasia - Narrow angle glaucoma - Pregnancy Lactation <12 2.3 Methylxanthine (Aminophylline) acute severe asthma Status asthmaticus ß2-agonist - --
  10. 10. CPG - 03 9/11 Budesonide MDI 200 mg/puff 200-1600 mg / Prednisolone 5 mg 5-60 mg / 0.1-2 mg/kg / Dexamethasone 4 mg/Amp 5 mg Hydrocortisone 100 mg/vial 1-2 mg/kg 6 0.5-1 mg/kg 6 Berodual Forte (4cc) Ipratropium 500 mcg Fenoterol 125 mcg 1-4 Berodual Inhaler Ipratropium 200 mcg Fenoterol 500 mcg 1-8 Puff / Salbutamol Inhaler Salbutamol 100 mcg/puff 1-2 Puff 4- 6
  11. 11. CPG - 03 10/11 Salbutamol NB Salbutamol 0.5 > 12 0.5-1 cc 4-6 < 12 > 20 0.5 cc 4-6 < 12 < 20 0.25 cc 4-6 Salbutamol 2 mg/ 1 2 mg/ 1 Dose - < 2 0.1-0.2 mg/kg 2-6 0.1-0.2 mg/kg Max 12mg/day 6-12 2 mg. Max 24mg/day > 12 2-4 mg. Max 32mg/day >70 2 mg. Max mg/day Seretide Salmeterol 25 mg Fluticasone 50 125 mg 1-4 Puff /day
  12. 12. CPG - 03 11/11 Aminophylline 250 mg/ 10 ml 4 mg./kg/dose 8 ( mg) 1. Asthma, COPD PEF Bronchodilator Bronchodilator PEFR 2. PEFR PEFR – PEFR ____________________ x 100 PEFR Chest X-ray
  13. 13. CPG - 03 12/11 Asthma , COPD Bronchiectasis 2. Intermittent Persistent 1. ≥ 1 2. ≥ 2 3. PEFR < 80 % - Persistent ICS ( step 2 ) - Intermittent Reliever as needed Easy Asthma Clinic Step 1. 2.
  14. 14. CPG - 03 13/11 3. 4. 5. Step ß2- agonist as needed 2. ICS (low dose) 3. ICS (low dose) + LABA 4. ICS (low dose) + LABA + Xanthine 5. ICS (medium dose) +LABA + Xanthine 6. ICS (high dose) +LABA + Xanthine Step Salbutamol Inhaler prn Budesonide 1 2 Puff / day Budesonide 1 x 2 + Seretide (25/50) 1 2 P / day Seretide (25/50) 2 x 2 Seretide (25/50) 2 x 2 + Theophylline Seretide (25/125) 2 x 2 + Theophylline Budesonide 1 x 2 + Seretide (25/125) 2 x 2 + Theophylline Budesonide 2 x 2 + Seretide (25/125) 2 x 2 + Theophylline Budesonide 3 x 2 + Seretide (25/125) 2 x 2 + Theophylline
  15. 15. CPG - 03 14/11 7. ICS (high dose) +LABA + Xanthine + Prednisolone Budesonide 3 x 2 + Seretide (25/125) 2 x 2 + Theophylline +Prednisolone dose Steroid Step Budesonide 1x1 1.1. Intubation - Unstable vital signs - Respiratory Rate > 35 /min - - - Respiratory failure - Hypoxia = Cyanosis, Air hunger - O2 Sat < 95 - Cardiac or Respiratory arrest
  16. 16. CPG - 03 15/11 - - Secretion obstruction ß2 agonist NB ê O2 6 /min O2 Sat - Dexamethasone mg stat Prednisolone 6 Tb stat - IV Fluid - Lab CXR, CBC, U/A 1.2 Severity > 5 - RR < 30 RR 30-40 RR > 40 ≤ 5 RR < 40 RR 40-60 RR > 60
  17. 17. CPG - 03 16/11 Retraction Retraction 1 Retraction > 1 Wheezing Expiratory wheezing Inspiratory Expiratory 4. O2 Sat ≥ 95 - Scores Total Score ≥8 - Salbutamol NB Stat - Dexamethasone 8 mg v Stat
  18. 18. CPG - 03 17/11 - Admit Refer 2. Total Score 4-7 Dexamethasone 8 mg v Stat- Salbutamol NB Severity Score o Severity Score < 4 D/C o Severity Score > 4 o Severity Score > 4 Admit Total Score < 4 - Prednisolone 6 tab stat Salbutamol NB Severity Score < 4 D/C -- Prednisolone 2x3 Antibiotics, Antihistamine -
  19. 19. CPG - 03 18/11 -- ≥ 8 ≤ 7 Bronchodilator NB Stat Dexamethasone 8 mg v stat Bronchodilator Asthma Severity Score
  20. 20. CPG - 03 19/11 ADMIT REFER ≥4<4 Discharge with F/U Bronchodilat or 2 ≥4 ≥ 4 <4 < 4 Discharge with F/U Bronchodilat or 3 ≥4<4 4 Discharge with F/U Admit
  21. 21. CPG - 03 20/11
  22. 22. CPG - 03 21/11
  23. 23. CPG - 03 22/11
  24. 24. CPG - 03 23/11
  25. 25. CPG - 03 24/11
  26. 26. CPG - 03 25/11
  27. 27. CPG - 03 26/11
  28. 28. CPG - 03 27/11
  29. 29. CPG - 03 28/11
  30. 30. CPG - 03 29/11
  31. 31. CPG - 03 30/11
  32. 32. CPG - 03 31/11
  33. 33. CPG - 03 32/11
  34. 34. CPG - 03 33/11
  35. 35. CPG - 03 34/11
  36. 36. CPG - 03 35/11

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