Asthma & Viral Induced Wheeze

Asthma and Viral Induced Wheeze
Prereading :

Workbook Cases :
Case 1
A 2-year-old boy presents to ED with 2 days of coryza and cough and increased work of breathing this morning. He has had something similar before and was given a salbutamol inhaler which mum has been giving him every few hours at home. On presentation he has moderate increased WOB and when you listen to his chest he has global widespread wheeze.
1. What treatment would you start immediately after your initial assessment, including the dose and mode of delivery?
2. What further questions would you ask on history to elicit the severity of his illness?
3. Discuss whether you would use steroids in this child and if so what dose?
4. He seems to respond to the initial therapy, how would you manage this child from this point?
5. After several hours he is well maintained on 3-4 hourly Ventolin. You are going to discharge him home, what advice should you give to mum and what handout information should you include in your discharge pack?
6. Just as they are about to leave mum asks you if this means he has asthma, how will you respond to this question?

Case 2
A 7-year-old boy presents with worsening wheeze over the course of the morning. He has known asthma and is normally controlled on flixotide. He has been using hourly Ventolin at home over the last few hours with minimal improvement. On examination he has moderate to severe increased work of breathing and minimal air entry across his chest.
His observations are Temp 37.4, HR 150, RR 54, Sats 87% on RA.
1. Comment on his observations
2. What features on examination suggest severe or life threatening asthma?
3. What immediate treatments will you initiate what dose and how will it be delivered?
4. You decided to give back to back nebs and oral steroids but there is very little improvement, what treatments would you use next? Can you describe a step wise approach to escalating treatment?
5. When inserting an IV line you take a venous gas, can you interpret the results below and describe whether this will change your management?
pH 7.32 , pCO2 59, pO2 78, HCO3 24, Na+ 135, K+ 2.7