How bad is the wheeze?

 

This SAQ is worth 13 marks

A 4 year old girl has been brought to your ED with an exacerbation of asthma.

Question 1.
List 6 features of your examination that would lead to you concluding that this exacerbation is life-threatening in severity. (6 marks)


1. __________________________________________________________________________________________________

2. __________________________________________________________________________________________________

3. __________________________________________________________________________________________________

4. __________________________________________________________________________________________________

5. __________________________________________________________________________________________________

6. __________________________________________________________________________________________________



Question 2.
You have assessed the girl to be experiencing a life-threatening exacerbation of asthma.
List 5 treatments you would use including doses. (5 marks)


1. ______________________________________________________________________________________________

2. ______________________________________________________________________________________________

3. ______________________________________________________________________________________________

4. ______________________________________________________________________________________________

5. ______________________________________________________________________________________________



Question 3.
List the drugs you would use to facilitate intubation if necessary. Include doses. (2 marks)


1. ________________________________________________________________________________________________

2. ________________________________________________________________________________________________



 

This SAQ is worth 13 marks

A 4 year old girl has been brought to your ED with an exacerbation of asthma.

Question 1.
List 6 features of your examination that would lead to you concluding that this exacerbation is life-threatening in severity. (6 marks)

  • Consciousness – agitated, drowsy
  • Marked increased work breathing
  • Silent chest
  • Inability to talk
  • Tachypnoea
  • Tachycardia
  • Hypotension
  • Hypoxia

Pass 5/6



Question 2.
You have assessed the girl to be experiencing a life-threatening exacerbation of asthma.
List 5 treatments you would use including doses. (5 marks)

  • Oxygen via mask to keep sats >92%
  • SalbutamoI nebs 2.5 - 5mg continuous
  • Ipratropium 250mcg times 3 nebs in first hour
  • Steroid IV – methypred 1mg/kg or hydrocortisone 4mg/kg
  • SalbutamoI IV – 5-10mcg/kg bolus then infusion
  • Also accept MgSO4 – 50mg/kg bolus then infusion
  • Also accept aminophylline – 10mg/kg loading dose

1 mark for complete treatment with correct dose Pass 3/5



Question 3.
List the drugs you would use to facilitate intubation if necessary. Include doses. (2 marks)

Ketamine 1-2mg/kg
Sux 1-2mg/kg
Also accept other variations that seem sensible
Pass 2/2

Total pass 10/13 corrects to 7.5/10


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