My Asthma Cme
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Transcript of My Asthma Cme
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KURSUS PENGENDALIAN KECEMASAN PERUBATAN
DI HOSPITAL
Acute Exacerbation of Bronchial Asthma
Abdul Shakir Zainal Abidin
Jabatan Kecemasan & Trauma
Hospital Sungai Buloh
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Apa Itu Asma..
Asma merupakan sejenis penyakit saluran pernafasan yang berulang dimana saluran pernafasan menguncup, menjadi radang dan bengkak.
Ini menyebabkan pesakit sukar bernafas
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Penyebab AsmaBahan alergi/alahan
Bahan perengsa
Pencemar udara
Senaman
Cuaca
Jangkitan virus
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Tanda-tanda Penyakit
Batuk
Ketat Dada
Sesak Nafas
Nafas yang Berbunyi
Nadi cepat
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Menilai Sebelum Rx…Menilai Sebelum Rx…
Severity : Severity : mildmild moderatemoderate
severesevere
Life –threatening asthma Life –threatening asthma
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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 )
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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.
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Ipratropium Bromide ( Atrovent )
- Inhaled atrovent have lower onset but longer duration of action. - They have very few side effects. *Dry mouth.
Perubatan….Perubatan….
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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…..
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Rawatan bagi…
1.Acute Mild Asthma ( Adult )
2.Acute Moderate Asthma ( Adult )
3.Acute Severe Asthma ( Adult)
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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.
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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.
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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..
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- 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.
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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.
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- Chest x-ray.- ABG.- Admit ward.
- IV Aminophyline infusion : - 0.5 mg - 0.9 mg / kg / Hour.
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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
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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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THANK YOU