KURSUS PENGENDALIAN KECEMASAN PERUBATAN

DI HOSPITAL

Acute Exacerbation of Bronchial Asthma

Abdul Shakir Zainal Abidin

Jabatan Kecemasan & Trauma

Hospital Sungai Buloh

Apa Itu Asma..

Asma merupakan sejenis penyakit saluran pernafasan yang berulang dimana saluran pernafasan menguncup, menjadi radang dan bengkak.

Ini menyebabkan pesakit sukar bernafas

Penyebab AsmaBahan alergi/alahan

Bahan perengsa

Pencemar udara

Senaman

Cuaca

Jangkitan virus

Tanda-tanda Penyakit

Batuk

Ketat Dada

Sesak Nafas

Nafas yang Berbunyi

Nadi cepat

Menilai Sebelum Rx…Menilai Sebelum Rx…

Severity : Severity : mildmild moderatemoderate

severesevere

Life –threatening asthma Life –threatening asthma

Di Asthma BayDi Asthma Bay

- Pesakit diberi Nebulizer.

- Semasa Nebulizer tanda- tanda vital diambil.

- Perhatikan heart rate kerana pesakit mungkin mendapat severe tachycardia – tachyarrythmia ( SVT / VT )

Perubatan AsthmaPerubatan Asthma

Bronchodilators.Beta 2 - agonist. - Most effective bronchodilators available. - Safe drugs with few side effects when taken by inhalation. - Tremors & tachycardia.

Bricanyl / Terbutaline Sulphate.Salbutamol / Ventolin Solutions.

Inj. Bricanyl 0.5 mg.

Ipratropium Bromide ( Atrovent )

- Inhaled atrovent have lower onset but longer duration of action. - They have very few side effects. *Dry mouth.

Perubatan….Perubatan….

Anti inflamatory using corticosteriod. - Main prophylactic drugs in adult asthmatics.

Tab Prednisolone 5mg / tab.Syrup Prednisolone 1mg / kg / dose.

IV Hydrocortisone 200 mg.

Perubatan…..Perubatan…..

Rawatan bagi…

1.Acute Mild Asthma ( Adult )

2.Acute Moderate Asthma ( Adult )

3.Acute Severe Asthma ( Adult)

Rawatan..Rawatan..

1. Acute Mild Asthma. ( Adult )

- PEFR > 75% - Beta 2 agonist neb. - Observe around 60 minutes. - If symptom is relieved with 1st neb - discharge with medication.

Upon Discharge: - Health Education. * Make a regular follow up at the nearest Health Clinic. * If not relieved with inhaler,please come to ED . * To teach Inhaler technique. - If patient cannot tolerate with 1st neb –give 2nd neb. - Prepare for Moderate Acute Asthma Mx.

2. Acute Moderate Asthma. ( Adult )

- PEFR 50 - 75 % - Beta 2 agonist ( 2nd neb + Atrovent 0.5 mg.) - Corticosteroid: - If patient can tolerate orally. * Tab Prednisolone 30 mg stat. * Syrup Prednisolone 1mg / kg / dose. - If patient cannot tolerate orally. * IV Hydrocortisone 200 mg stat.

Continue..

- S/C Bricanyl 0.5 mg stat. - IV Aminophyline 250 mg in 1 pint N/Saline ( Run in 1 H ) - Chest x-ray. - Antibiotic. - If symptom is relieved by medication - for discharge. - Discharge with Tab Prednisolone 30 - 40 mg daily for 1/52. - If pt does not respond to medication - repeat another neb. - Prepare for Acute Severe Asthma Mx.

3. Acute Severe Asthma. ( Adult )

- PEFR ( < 50% ) - Beta 2 agonist + Atrovent 0.5 mg. - Oxygen < 40%-60% via Nasal Cannula. - Steroid - IV Hydrocortisone 200 mg - stat. - IV Bricanyl 0.5 mg stat. - IV Aminophyline 250 mg slow bolus over 15 - 20 minutes.

- Chest x-ray.- ABG.- Admit ward.

- IV Aminophyline infusion : - 0.5 mg - 0.9 mg / kg / Hour.

Confusion or unconscious or convulsion Confusion or unconscious or convulsion ExhaustedExhausted Feeble respiratory effort Feeble respiratory effort Bradycardia / hypotensionBradycardia / hypotension Silent chest on auscultation Silent chest on auscultation ?PEFR < than 30% ?PEFR < than 30%

Life-threatening AsthmaLife-threatening Asthma

Education of patient & family should include the following information:

1. Nature of Asthma - frequency of asthma attack.2. How to use inhaler.3. When to use inhaler. 4. It must be understood which inhaler “Prevents” & which “Relieves”5. Self monitoring by Peak Flow measurement can be taught in asthmatic patient.

Pendidikan Kesihatan

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