Question

Poppy is a 9 year old female, weight 40Kg.

She presented to ED with worsening respiratory symptoms over the past few hours. Her parents state she is unable to

talk in full sentences or undertake a peak flow. In ED Poppy has been given 3 x 20 minutely nebulised Salbutamol with

6LPM of O2, IVF commenced, Stat dose of Prednisone administered, Chest X-ray shows hyperinflation of both lung

fields. She was admitted to ICU due to her deteriorating respiratory function with a diagnosis of acute exacerbation

of asthma.

EXCERPT OF RELEVANT ICU NOTES

Past History

Diagnosed with asthma age 2 (infrequent intermittent asthma).

7

Current medications: - Ventolin PRN.

IUTD (immunisations up to date)

Nursing Assessment

A. Clear, speaking in single words

B. RR 42bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and

expiratory wheeze

C. HR 160bpm, ST, peripherally warm

D. GCS 14/15 (E4, V4, M6)

E. Accessory muscle use, shoulder shrugging on inspiration, tracheal tug

F. IVF NaCl 53 ml/hr

G.

a. Mg- low 0.60mmol/L (0.70-1.10mmol/L) all other pathology is normal.

b. BGL 9.0mmol/L

c. Beta-agonist- Salbutamol

d. Anticholinergic - Atrovent

e. IV Hydrocortisone

f. ABG shows respiratory acidosis, (PH 7.32, PaCO2 49, PaO2 70, HCO3 27, BE -2.1, Lactate

1.4)

Plan

- Keep SpO2 92-95%%

- Beta- antagonist Salbutamol continuous via nebuliser

- Anticholinergic Ipratropium bromide (Atrovent) 500ug 4/24

- Hydrocortisone 100mg 6/24

- MgSO4 6.4mmol/20 minutes

- IVF 53ml/hr

- Repeat ABGs in 1hour

- Monitor BGL

- Peakflow /spirometry

QUESTION:

Salbutamol via nebuliser

Why your patient is receiving this medication in relation to her symptoms and diagnosis?

Answer 1

Asthma is due to immune response in bronchial airway by T-helper -2, IgE mediated mast cell release, cytokine release are various mechanism involved. These immune response causes inflammation of bronchial airway and also cause smooth muscles contraction of bronchial airway , all these makes air pathway narrow and decrease air flow to alveoli that cause various symptoms in asthma patients like wheezing, breathlessness, etc.

Salbutamol is beta adrenergic agonist drug that cause smooth muscle relaxation in bronchial airway, that is the reason it is used as immediate measure for asthmic patient.

Anticholinergic drug like ipratropium bromide has also same outcomes as salbutamol but with different mechanisms by reversing the cholinergic effect on smooth muscle of bronchial airway.

Prednisolone is a corticosteroid drug and it decreases the exaggerated immune response. Prednisolone produce effect late but is very effective and long lasting effect. Thats why it is not used for acute attack but used to prevent further deterioration.

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DR. PRADY