Asthmatic status AKPER PEMKAB MUNA
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This document discusses asthmatic status and the treatment of severe asthma exacerbations. It defines a severe exacerbation as one that is unresponsive to usual asthma drugs. Potential causes include allergens, stress, emotions, infections, and irritants. Severe exacerbations involve hyperresponsiveness and inflammation in the bronchi leading to hypersecretion, edema, and bronchoconstriction. Treatment depends on the severity of the exacerbation and includes nebulized bronchodilators, corticosteroids, oxygen supplementation, and mechanical ventilation for the most severe cases unresponsive to initial treatment.
Asthmatic status AKPER PEMKAB MUNA
- 1. ASTHMATIC STATUS Sumirah BP SKp, M.Kep
- 2. DEFINITION A severe asthma exacerbation which isA severe asthma exacerbation which is not responsive to drugs that are usuallynot responsive to drugs that are usually given for asthma exacerbation.given for asthma exacerbation.
- 3. ETIOLOGY MULTIFACTORIALMULTIFACTORIAL ALERGENALERGEN RESTLESSNESSRESTLESSNESS EMOSIONEMOSION INFEKSIONINFEKSION INHARATEDINHARATED
- 4. PATHOGENESIS HYPERRESPONSIVENESS & INFLAMATION PROCESS OF BRHONCUS • HYPERSECRETION • OEDEMA • BRONCHOCONSTRICTION
- 5. Classification of Severity of Acute Asthma Exacerbations Parameters Mild Moderate Severe Respiratory Arrest Imminent Breathlessness While walking While talking While at rest Talks Sentences Phrases Words Position Can lie down Prefers sitting Sits upright Alertness Maybe agitated Usually agitated Always agitated Confused/ drowsy Cyanotic - - + +++ Wheeze Moderate, often only end expiratory Loud, throughout expiratory ± inspiratory Extremely loud, can be heard without stethoscope Absence of wheeze
- 6. Breathlessness Minimal Moderate Severe Use of accessory muscles Usually not Commonly Always Retractions Shallow, intercostals Moderate, + suprasternal Deep, + flare of alae nasi - Respiratory rate Increased Increased Increased Decreased Guide to rates of breathing in awake children: Age: Normal rate: < 2 month < 60 / minute 2-12 months < 50 / minute 1-5 years < 40 / minute 6-8 years < 30 / minute
- 7. Pulse Normal Tachycardia Tachycardia Bradycardia Guide to normal pulse rates in children: Age: Normal rate: 2-12 months < 160 / minute 1-2 years < 120 / minute 3-8 years < 110 / minute Pulsus Paradoksus None < 10 mmHg (+) 10-20 mmHg (+) > 20 mmHg None PEFR or FEV1 -before b.dilator -after b.dilator (% pedicted va- > 60% > 80% lue/ % best value) 40-60% 60-80% < 40% < 60 % respons < 2 jam SaO2 > 95% 91-95% ≤ 90% PaO2 Normal > 60 mmHg < 60 mmHg PaCO2 < 45 mmHg < 45 mmHg > 45 mmHg
- 8. Pulse Normal Tachycardia Tachycardia Bradycardia Guide to normal pulse rates in children: Age: Normal rate: 2-12 months < 160 / minute 1-2 years < 120 / minute 3-8 years < 110 / minute Pulsus Paradoksus None < 10 mmHg (+) 10-20 mmHg (+) > 20 mmHg None PEFR or FEV1 -before b.dilator -after b.dilator (% pedicted va- > 60% > 80% lue/ % best value) 40-60% 60-80% < 40% < 60 % respons < 2 jam SaO2 > 95% 91-95% ≤ 90% PaO2 Normal > 60 mmHg < 60 mmHg PaCO2 < 45 mmHg < 45 mmHg > 45 mmHg
- 9. TREATMENT Klinik / IGD Nilai derajat serangan (1) Tatalaksana awal nebulisasi β-agonis 1-3x, selang 20 menit (2) nebulisasi ketiga + antikolinergik jika serangan berat, nebulisasi 1x (+antikoinergik) Serangan ringan (nebulisasi 1x, respons baik, gejala hilang) observasi 1-2 jam jika efek bertahan, boleh pulang jika gejala timbul lagi perlakukan sebagai serangan sedang Serangan sedang (nebulisasi 2-3x, respons parsial) berikan oksigen (3) nilai kembali derajat serangan, jika sesuai dgn serangan sedang, observasi di Ruang Rawat Sehari pasang jalur parenteral Boleh pulang bekali obat β-agonis hirupan / oral) Jika sudah ada obat pengendali, teruskan jika infeksi virus sbg pencetus, dpt diberi steroid oral dalam 24-48 jam kontrol ke Klinik R. jalan utk reevaluasi Serangan berat (nebulisasi 3x, respons buruk) sejak awal berikan O2 saat / di luar nebulisasi pasang jalur parenteral nilai ulang klinisnya, jika sesuai dgn serangan berat, rawat di Ruang Rawat Inap Foto Rontgen toraks Ruang Rawat Sehari oksigen teruskan berikan steroid oral nebulisasi tiap 2 jam bila dalam 8-12 jam perbaikan klinis stabil boleh pulang jika dalam 12 jam klinis tetap belum membaik, alih rawat ke Ruang Rawat Inap Ruang Rawat Inap oksigen teruskan atasi dehidrasi & asidosis jika ada steroid IV tiap 6-8 jam nebulisasi tiap 1-2 jam aminofilin IV awal, lanjutkan rumatan jika membaik dlm 4-6x nebulisasi, interval jadi 4-6 jam jika dlm 24 jam perbaikan klinis stabil, boleh pulang jika dgn steroid & aminofilin parenteral tidak membaik, bahkan timbul Ancaman henti napas, alih rawat ke Ruang Rawat Intensif Catatan : 1. Jika menurut penilaian serangannya berat, nebulasi cukup 1x langsung dgn β-agonis + antikolinergik 2. Jika tdk ada alatnya, nebulisasi dpt diganti dgn adrenalin subkutan 0,01 ml/kgBB/kali maksimal 0,3 ml/kali 3. Utk serangan sedang & terutama berat, oksigen 2-4 L/mnt diberikan sejak awal, termasuk saat nebulisasi
- 10. TREATMENT IN PICU • MEDICINES AT WARD IS CONTINUED • MECANICAL VENTILATOR