DundeeChest 3.0

Confused 2nd year student, Anna, says:

Hi – I’m struggling to comprehend the management of acute asthma. I was just looking in a textbook and at the BTS Guidelines management of acute asthma – but I’m still a little confused.

What do you give and in what order and how much?

I know you give O2 to maintain sats at 94-98% and nebulised Salbutamol – but how much? What is the dose for Ipratropium? – Inregards to steroids again BTS simply mentions “Give steroids in adequate doses in all cases of acute asthma. Continue Pred. 40-50mg daily for at least 5/7 or until recovery” – what is the starting dose? and what is the clinical indication/point at which IV magnesium is considered?
Is there a Tayside Protocol? I’m sure there must be one, but I can’t find it.
Thanks – I’m probably confused over something really simple, but I’d really appreciate the clarification as I don’t want to mistreat a patient one day!

In order:

Oxygen – yes, you have it right.
Salbutamol – 5 mg, nebulised, driven by oxygen, not air
Ipratropium- 500 mcg nebulised, driven by oxygen, not air
Steroids – 50 mg prednisolone PO, or 200 mg hydrocortisone IV. Locally we give 25 mg prednisolone BD for the acute phase, and swap to 50 mg OD for discharge. We usually give 5 to 7 days, or until they get better.
IV Magnesium – it’s on the protocol, and we do use it. 1.2 – 2 g MgSO4 given IV over about 20 minutes. We say to give it if there are any life threatening features. The evidence for it is mixed, but anecdotal evidence is striking. Don’t let IV magnesium administration delay calling the anaesthetists when the patient begins to develop type 2 respiratory failure.

The Tayside protocol is stuck on the wall in ward 15, it’s in the protocol book in ward 15, and it’s on the intra-net somewhere. I’ll try to dig out an electronic version and post it up here.