Download Asthma - National First Aid

22024VIC
Emergency
Asthma Management
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Objectives
Upon completion of this course you will be able to:
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Describe asthma and recognise the signs and symptoms
List the causes (triggers) of an asthma attack
Recognise and identify a potential asthma emergency
Understand and discuss the various types of medication and
delivery devices used for asthma management
• Apply / manage treatment for a mild/moderate and severe
asthma attack
• Apply / manage first aid principles in an undiagnosed patient
• Understand the requirements for risk minimization and
management strategies for an asthma emergency
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Course Outline
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What is Asthma?
Identifying Asthma Triggers
Stages of an Asthma Attack
Asthma Medications
Asthma Delivery Devices
First Aid for Asthma
Asthma Risk Management
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What is Asthma
• Asthma is a disease where inflammation of the
airways causes airflow into and out of the lungs to
become restricted
• During an asthma attack, mucus production
increases, muscles of the bronchial tree tighten and
the lining of the air passages swell
thereby reducing airflow, producing
the characteristic wheezing sounds
• This results in breathing difficulty
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Asthma Facts
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The cause of asthma is unknown
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Asthma can be diagnosed at any age
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Asthma can present quite differently for each
person
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An asthma attack can happen without warning
at any time
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Asthma symptoms can be mild, moderate and life-threatening
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There is no cure for asthma, however, asthma can be well managed
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Generally, people with asthma can lead quite normal lives when their asthma is well
managed
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Asthma Statistics (Australia 2011)
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1 in 10 children in Australia have diagnosed asthma
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On average more than one person dies each day from asthma, around
90% of these deaths are in people 40 years and older
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Children have higher rates of hospitalisation for asthma than adults,
this spikes in February after the school holidays
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About 40% of asthmatic children live with smokers
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More boys than girls have asthma, more women than men have
asthma ( it is based on the fact that boys have smaller airways and for
women it is hormone related)
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Poorly controlled Asthma in children can impact on both health and
learning
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Other linked allergies
• 60-80% of people with asthma have hay fever
(allergic rhinitis), often triggered by pollen
• Eczema(atopic dermatitis) occurs in 5 infants,
usually improves during the teenager years
• Food allergies occurs 1 in 20 children and
generally will resolve with time
• Anaphylaxis is the most severe form of allergic
reaction and is potentially life threatening
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Asthma Anatomy
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Asthma Airways
Three main factors cause the airways to become narrowed
Inflammation : The inside lining of the airways become swollen and red
Extra mucus : Increased amounts of mucus may be produced
Muscle Spasm : The muscle around the airways constricts or tightens
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Asthma Airways
People with asthma have sensitive
airways. When exposed to certain triggers
these airways become narrow, making
breathing difficult.
Asthma
Normal
Airway
Airway
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Asthma Triggers
Some examples are:
• Colds and flu, respiratory infections
• Cigarette smoke and emotional stress
• Exercise, physical activity or pre exercise warm ups
• Allergic reaction to pollen, insect sting, dust, smog,
food, medication, sprays, chemicals, preservatives
and moulds
• Exposure to sudden changes in the
weather, particularly cold and wet
conditions
Exercise, Colds/Flu, Smoke and Pollens are the most
common triggers.
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Asthma : How to Recognise
Signs & Symptoms
Can vary from person to person and may include:
• A dry, irritating, persistent cough, particularly at night
• Shortness of breath especially when talking
• Rapid breathing, wheezing sounds (but not always)
as the patient exhales (this may be absent in severe
attacks due to little air movement)
• Tightness across the chest
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Asthma : How to Recognise
Signs & Symptoms continued:
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Pale, sweaty skin
Becoming progressively anxious, distressed and tired
Becoming blue around the lips and ear lobes (cyanosis)
Drawing in of the air spaces between the ribs and above
the collar bones with each breathing effort
• Altered conscious responses
• Collapse, leading to respiratory arrest may occur in
severe attacks
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Stages of an Asthma Attack
Mild :
Slight breathing difficulty, wheezing, cough
Moderate :
Breathing difficulty at rest. Use of accessory muscles in order to breathe.
Less air exchange, wheezing, persistent cough, speaking in short sentences.
Severe :
Severe breathing difficulty. Use of accessory muscles in order to breathe.
Absent or increased wheezing. Showing signs of shock.
Respiratory Failure:
Use of accessory muscles in order to breathe. No response to medication. No wheezing.
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Asthma Medications
Medications are divided in to three classes
Relievers
Preventers
Controllers
Combinations
Airomir
Asmol
Atrovent
Bricanyl
Ventolin
Alvesco
Flixotide
Intal Forte
Pulmicort
Singular
Tilade
Qvar
Oxis
Serevent
Foradile
Seretide
Symbicort
Combination medications are a combination of 2 classes
symptom preventer and symptom controller medications
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Asthma Medications
Preventer
Reliever
Preventer
&
Controller
Combination
Medication
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Asthma Medication Relievers
• Known as Broncodilators (blue/grey)
• Relaxes the tight muscles around the
airways for about four hours allowing air to
move easily through the airways.
• Works quickly (within minutes), generally
lasts up to 4 hours
• Should be used in asthma first aid
• Safe – cannot overdose
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Asthma Medication Preventers
• Known as Anti-inflammatories
• Preventer medication reduces the
frequency and severity of attacks if taken
regularly everyday.
• They reduce/control inflammation and
sensitivity of the airways
• Preventers should not be used in asthma
emergencies
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Asthma Symptom Controllers
• Symptom Controllers are long acting
relievers, they relax muscles around the
airways for up to 12 hours
• They are taken in conjunction with
preventer medication
• Symptom Controllers should not be used
in asthma emergencies because of the
delay in onset of action of 1-2 hours
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Asthma Medication
Combinations
• Combination Medication contains a preventer
and a symptom controller together in one inhaler
• Combination Medication should not be used in
asthma emergencies
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Asthma Medication – Side Effects
• No harm is likely to result from administering
a reliever medication to a patient who is not
experiencing asthma.
• Reliever medications are safe. An overdose is
unlikely. Some minor side effects may be
experienced (muscle tremors, elevated heart
rate).
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No Asthma Reliever Medication
Available?
If you suspect an individual is experiencing an asthma attack
and reliever medication is not available
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Sit the patient upright / leaning slightly forward
Rest and reassure
Loosen tight / restrictive clothing
Encourage controlled breathing (slow / deep)
If there is little or no improvement
or you are unsure:
Call Ambulance 000
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Asthma Delivery Devices
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Using an Autohaler
Not recommended for children under 7
Shake the Autohaler in order to mix the medication and propellant.
2. Remove cover from the mouthpiece and hold it upright without blocking
vents at the base.
3. Lift grey lever at top of device.
4. Breathe out.
5. Tilt chin up.
6. Insert mouthpiece (seal well with lips).
7. Breathe in through mouth slow, steady and deep for 5 seconds if possible.
The Autohaler will automatically emit a dose of medication.
8. Remove Autohaler, close mouth and hold breath for
up to 10 seconds.
9. Slowly breathe out through the nose.
10. Return grey lever to its original position.
11. Repeat steps 2 to 9 until breathing is relieved
1.
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Using an Accuhaler
Not recommended for children under age 8
1. Hold the Accuhaler in one hand by its base.
2. Place thumb of the other hand on the thumb grip.
3. Open Accuhaler by pushing thumb grip around until it clicks.
4. Slide lever until it clicks.
5. Breathe out away from Accuhaler.
6. Insert mouthpiece seal well with lips.
7. Breathe in through mouth slow, steady and deep for 5 seconds if possible
8. Remove Accuhaler and hold breath for up to 10 seconds if possible.
9. Breathe out gently - away from Accuhaler.
10. Close Accuhaler.
11. Repeat steps 2 to 9 until breathing is relieved
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Using an Turbuhaler
Not recommended for children under 7
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Unscrew and lift the cap off.
Hold the Turbuhaler upright.
Twist the coloured base to the right then left, until it clicks.
Breathe out gently away from the device. Do not blow on it.
Insert the mouthpiece seal well with lips.
Breathe deeply in through the mouth with force for approximately 5
seconds.
7. Remove the Turbuhaler from mouth before breathing out.
8. Replace the cap.
9. Repeat steps 2 to 9 until breathing is relieved
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Spacer Delivery Devices
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Spacer Delivery Devices
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Spacer Delivery Devices
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Recommended for both adults and children with an asthma puffer
Greatly increases the amount of medication reaching the lungs
Reduces medication deposited at the back of the mouth and throat
For children up to 5 years old a mask and small volume spacer is
recommended
Infection Control
• Spacers are for use by one person only
• The National Health and Medical Research Council guidelines have
removed the cleaning of spacers for multiple people (unless the
spacer can be autoclaved). This avoids infection transmission by
mucus.
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Using a spacer is more effective
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Using a Metered Dose Inhaler
(Puffer with spacer)
• Shake the inhaler
• Place the mouthpiece into the spacer
• Place the spacer mouthpiece into the
patient’s mouth
• Administer one puff into the spacer and
ask the patient to breathe in and out
normally for four breaths.
• Repeat this promptly until four puffs have
been given
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Using a Metered Dose Inhaler
(Puffer without spacer)
• Shake the inhaler.
• Place the mouthpiece into the patient’s
mouth and administer one puff as the
victim inhales slowly and steadily.
• Ask the patient to hold their breath for four
seconds and then take four normal
breaths.
• Repeat this promptly until four puffs have
been given.
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Asthma First Aid
Step 1
• Sit the patient upright, leaning forward with
elbows extended, resting on a soft support like
pillow. This helps to expand the rib spaces.
• Remove any tight or restrictive clothing
• Do not leave the patient alone. (Send someone
else to get the asthma first aid kit)
• Be calm and reassuring.
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Asthma First Aid
Step 2
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Shake blue reliever puffer medication
Use spacer if available
Put 1 puff into spacer
Take 4 breaths from spacer
Repeat until 4 puffs have been taken
Note : shake puffer, 1 puff to 4 breaths, repeat 4 times
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Asthma First Aid
Step 3
• Wait 4 minutes and closely monitor the
patient’s condition.
• If there is little or no improvement, keep
giving 4 puffs, 4 breathes for a further
4 minutes
If oxygen is available, it should be administered at a
flow rate of 8 litres per minute via a face mask, by a
first aider trained in its use.
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Asthma First Aid
Step 4
If :
• there is still little or no improvement
• you are unsure
• there is no blue reliever puffer medication
Then you:
• CALL AMBULANCE 000 immediately – tell
the operator the patient is having an
asthma attack
• Keep repeating the 4 puffs x 4 breaths x 4
minutes until Ambulance arrives
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First Asthma Attack ?
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If a patient is in respiratory distress and you suspect
it may be asthma:
Call Ambulance 000 first
Follow the 4 x 4 x 4 Asthma first aid
Keep repeating the until Ambulance arrives
Rest and reassure the patient
Treatment can not cause harm even if it is not asthma
A first attack can be as serious as any other attack
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Is it Asthma or Anaphylaxis?
If the patient is known to be at risk of anaphylaxis and
you are unsure you should:
• Give the adrenaline auto injector first
• Then give asthma reliever medication
Adrenaline will also help relieve the asthma symptoms
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Unconscious Asthmatic
• Follow DRSABCD
• Call Ambulance 000
• Place into the recovery position and
closely monitor response, airway,
normal breathing while waiting for the Ambulance
• Be prepared to resuscitate
In some cases where breathing has stopped due to
severe asthma, you may need to blow harder to
inflate the lungs and at a slower rate to allow air to
escape when performing rescue breaths.
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Asthma First Aid Plan
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The Asthma First Aid Plan is developed in consultation with the individuals doctor
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It is a written plan outlining their asthma management
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The plan includes use of medications
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It outlines the individuals signs, symptoms & triggers
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Is a precise 4 step plan to be followed in the event of an asthma episode
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Most people with asthma do not have an Asthma Plan
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If the individual Asthma Plan is not available, follow the standard 4x4x4 Asthma First
Aid Plan
Plans can be downloaded from www.nationalasthma.org.au
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My Asthma Action Plan
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Asthma First Aid Kit
• An Asthma first aid kit contains all of the necessary items that are
needed in case of an asthma attack.
• Mobile kits should be accessible at all times and available in the
event of excursions, camps or off site activities.
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The kit needs to include:
– Blue reliever puffer
– 2 spacer devices (and two masks if under 5 year old are in your
care) – these are single use spacers
– An incident record book needs to be included (detailing the
management procedure undertaken).
– Instructions for asthma first aid
Regularly check the first aid kits to ensure
all equipment is in date, clean and good condition
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Asthma First Aid Kit
Location
• Visible / accessible
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Portable
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Not in direct sunlight
Maintenance
• Procedures – who is responsible for checking?
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Checking procedures (expiry date of MDI)
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Who can access the kit?
It is recommended that at least two kits are available – one for on-site
and one mobile kit.
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Asthma - Risk Management
A risk management policy is required to document
strategies for implementation of best practice asthma
management .
Key points:
• All staff are aware of which individuals are
asthmatic.
• All individuals who have asthma can receive
appropriate attention as required.
• Staff can respond to the needs of those who have
not been diagnosed with asthma and who may be
having an asthma attack or difficulty breathing.
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Risk Management - Management
• Identify individuals with asthma during the enrolment
process.
• Provide parents with a copy of the school’s Asthma Policy
upon enrolment if requested.
• Provide all staff with a copy of the Asthma Policy and brief
them on asthma procedures upon their appointment .
• Provide opportunity and encouragement for staff to attend
regular asthma training and ensure that at least one trained
member of staff is present during all onsite and offsite
activities and excursions.
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Risk Management - Management
• Provide an Asthma Record upon enrolment. The
completed Asthma Record is to be returned promptly,
reviewed annually and filed in the medication file.
• Ensure that all teachers are informed of students with
asthma in their care.
• Formalise and document school procedures for Asthma
First Aid for all individuals diagnosed with asthma and also
for those with no known diagnosis (first asthma attack).
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Risk Management - Management
•Ensure that Asthma First Aid charts / posters are
displayed in key locations in the school.
• Ensure that the Asthma First Aid Kits contain a blue
reliever puffer, individual spacer devices (disposable)
and concise written instructions on Asthma First Aid
procedures.
• Provide a mobile Asthma First Aid Kit for use on
excursions and activities.
• Identify and where possible, minimise asthma
triggers.
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Risk Management - Staff
• Ensure that staff maintain current training in managing an
asthma emergency (currently every three years).
• Ensure that staff are aware of any individual in their care
with asthma.
• Optimise the health and safety of each student through
supervised management of their asthma where required.
• Ensure that all regular prescribed asthma medication is
administered in accordance with the information on the
student’s personal Asthma Record or Asthma Action Plan.
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Risk Management - Staff
•Administer emergency asthma medication if
required according to the Asthma Action
Plan. If an Asthma Plan is unavailable, the
Standard Asthma First Aid Plan should be
followed immediately.
• Promptly communicate to the Principal and
where applicable, families, any concerns
about asthma limiting a student’s ability to
participate fully in all activities.
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Risk Management - Staff
• Regularly maintain all asthma components of the first aid
kit to ensure all medications are current and individual
devices are available and ready to use.
• Encourage asthmatics to carry their reliever medication
and use their medication as soon as symptoms develop.
• Identify and where possible, minimise asthma triggers.
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Risk Management - Families
Families will:
• Inform staff, either upon enrolment or initial diagnosis, if
there is a history or medical condition of asthma.
• Provide all relevant information regarding the student’s
asthma via the Asthma Action Plan in consultation with their
doctor.
• Notify management in writing, of any changes to the
Asthma Action Plan throughout the year.
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Risk Management - Families
• Ensure that an adequate supply of appropriate
medication (reliever) and a spacer device (clearly
labelled) is provided where applicable with the
student’s name.
• Ensure that all medication is within valid use by
dates.
• Communicate all relevant information and concerns
with staff as the need arises.
e.g. if asthma symptoms were present during the night
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Activity
• PRACTICE:
– Demonstrate use of MDI/spacer
– Follow Asthma Plan
– Scenario/Role play
– Risk Management
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