Miss Emma Spencer, a 22-year-old known asthmatic, presented to the emergency department short of breath after being exposed to a cat. On examination, she had wheezing, reduced chest expansion, and a peak flow of 200. She was treated with oxygen, nebulized salbutamol and ipratropium bromide, intravenous hydrocortisone, and oral prednisolone for a severe acute asthma exacerbation triggered by her cat allergy.

1. DR AMIT THAKRAR · DR KUSHAN KARUNARATNE

2. Acute Asthma
Scenario
• Miss Emma Spencer is 22 years old (30/07/1990). She has come to A&E feeling increasingly
short of breath since this morning.
• Obs: P 120; RR 30; BP 125/80; Sats 94%; T36.5
• She is a known asthmatic and says she has been feeling wheezy all weekend. She is in
London visiting a friend. Miss Spencer says her friend owns a cat and thinks this may have
triggered her asthma. Unfortunately she has forgotten her inhalers at home. Her normal
peak flow is 500.
• PMHx: asthma, hay fever
• DHx: Salbutamol inhaler 2 puffs PRN, Beclometasone 200micrograms inhaler BD
• Allergy: Penicillin – anaphylaxis.
• O/E: Unable to talk in full sentences CRT <2s; Pulse regular; Chest bilateral wide spread
expiratory wheeze, reduced chest expansion; HS I+II+0
• Investigations: Peak flow 200 (best of three). CXR – normal.
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3. British Thoracic Society Guidelines
BNF Section 3.1
(approx. p179)
• Assess
severity
• OSCE scenario
is likely to be
severe acute
asthma
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4. A&E Dr Cox
John Dorian
21/10/2012
PETER
SKINNER
30/07/1960
JD
21/10/2012
PENICILLIN – ANAPHYLAXIS
21/10 OXYGEN 15L 08:00 NRB JD
21/10 SALBUTAMOL 5mg 08:00 NEB JD
500
21/10 IPRATROPIUM BROMIDE micrograms 08:00 NEB JD
21/10 HYDROCORTISONE 100mg 08:00 IV JD
21/10
OXYGEN 15L NRB MAINTAIN
SATS >94%
21/10/12 JD
SALBUTAMOL 5g NEB 4 HOURLY
21/10/12 JD
500
IPRATROPIUM BROMIDE micrograms NEB QDS
21/10/12 JD
PREDNISOLONE 40mg PO OM
21/10/12 JD
BECLOMETASONE 200 INHALED BD
micrograms
21/10/12 JD
ENOXAPARIN 40mg S/C OD
21/10/12 JD
TEDS 1 PAIR TOP
21/10/12 JD
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5. PARACETAMOL
1g PO 21/10/12
JD QDS
SALBUTAMOL
5mg NEB 21/10/12
JD 2hrly
Summary
• Stat
– Oxygen 15L NRB (target O2 sats > 94%)
– Salbutamol NEB 5mg
– Ipratropium Bromide 500 micrograms NEB
– Hydrocortisone 100mg IV
• Regular
– Oxygen 15L NRB (target O2 sats > 94%)
– Salbutamol NEB 5mg 4 hourly
– Ipratropium Bromide NEB 500 micrograms QDS
– Prednisolone 40mg PO OM
– Enoxaparin 40mg S/C OD
– TEDS 1 Pair TOP
• PRN
– Salbutamol NEB 5mg 2 hourly
– Paracetamol 1g PO QDS
• Contraindicated
– NSAIDs, beta‐blockers, sedatives
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without written consent from the copyright holders. This document should not be used as your sole revision resource. 72