Question

1. Which of the following statements is true regarding a 4-year-old patient, 20kg experiencing a severe asthma exacerbation. VS:HR 130, RR 45, BP 105/68, Sats 84% A. Therapy includes albuterol, oral steroids, oxygen B. The patient is experiencing increased pulmonary resistance c. Patient should be intubated if the PCO2 is 58 on an arterial blood gas 10mg/hr of continuous albuterol E. He may receive nebulized albuterol with helium to improve drug delivery to the distal lung areas 2. A 2 year old male presents with acute onset of respiratory distress and is found to have wheezing on the right lung field and a pulse ox of 84% on RA What are your thoughts? What is your approach to this patient? 3. Choose the BEST match Solumedrol supraventricular tachycardia Magnesium bronchodilation Atrovent hypertension Terbutaline bronchodilation 4. There are important key factors that are involved in the pathophysiology of asthma. Choose the abnormal physiology listed on the left column with its clinical complication on the right column: High intrathoracic pressures Mucus plugging Bronchoconstriction wheezing pneumothorax low blood pressure death Hypoxemia 5. List the most common causes of acute decompensation in intubated asthmatics (The answer is not found in the article. Please take a few minutes to look up).

Answer 1

1.therapy include albuterol, oral steroids, oxygen

In the pediatric age sever asthma exacerbation is an emergency condition ,sever episodes leads to death,medical treatment is to reduce the condition ,

Salbutamol is a bronchodilator which helps in dilatation by relaxing the smooth muscles in the air way,acts on the beta 2 adrenergic receptors and leads to broncho dilatation

Steroids helps in reducing the exacerbation by reducing the mucus secretions

Hypoxia is reduced by oxygen supply

2.acute respiratory distress with wheeze inth right lung is due to obstruction in the lungs ,,wheeze is due to narrowing of the air passage or obstruction occurs in chronic obstructive pulmonary disease

Approach by advise ,self care and use of bronchodilators and steroid to reduce further damage to the lungs ,oxygen supply,advise to stop any habits like smoking ,and stop work or roaming in the dusty areas

3.terbutaline is a bronchodilator

Acts on the relaxation of smooth muscles leads to broncho dilation

4.high intra thoracic pressures

It increase during inspiration

5.decompensation means loss of compensation mechanism,intubation is due to give support to a patient who need assisted ventilation ,gives rest to the respiratory muscles by ventilating but some condition leads to decompensation loss of compensatory mechanism most common cause is intubation induced broncho spasm,hypotension,cardiac arrest,baro trauma and extubation.