CPG-03

PCT

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o Cardiogenic Conditions : - Congestive Heart Failure, MI
o

Pulmonary Conditions : - Pulmonary edema, Foreign Body,

Pneumothorax, Hemothorax, Pleural Effusion, Pulmonary
Tuberculosis, Pneumonia

o
o

: - GERD, Anaphylaxis

Asthma Bronchiectasis COPD (Emphysema +

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Chronic Bronchitis)

(Asthma)

( , ,
, )

- Rhinitis, Conjunctivitis
Dermatitis

-
-

- Wheezing

- Chest X-ray : - normal

- Bronchodilator test :- PEFR > 15%

( COPD )

2 Emphysema
Chronic Bronchitis

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-

-

- Lungs :- Ronchi, Crepitation Wheezing

- Decreased Breath sound

- Barrel chest

- Chest X-ray

Emphysema : - (AP diameter

)

- 7

Chronic Bronchitis :- Peribronchial

thickening

(Bronchiectasis)

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Chronic Bronchitis

- Lungs :- Ronchi, Crepitation,

Wheezing

:- 3

-
-

Chest X-ray :-

Peribronchial Thickening

Chronic Bronchitis
Lower lobe

Honeycomb appearance

1.

2.

3.

1.

( ER, Admit)

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2.

3.
4.

5.

1.

, ,

1)
2)

3)

4)

2.

3.
1)
2)

Care Plan

4.

Asthma

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2

Controllers Relievers

1. Controllers

Persistent
Inhaled Corticosteroids
(ICS)

1.1 Corticosteroids

- Inflammation

- mucous

- action 2-against

- Hypersensitivity

- Side effect Steroids ,

, , adrenal gland,
Bone mass

- ,

1.2 Long - acting 2- agonist

Salmeterol Fluticasone ( ICS ) Seretide

2 25/50 25/125

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Inflammation

- Corticosteroids

ICS

- ICS

1.3 Xanthine Sustained release (Thophylline SR)

- Inflammation

2. Relievers
3

2.1 Short-acting

2- agonist Salbutamol Inhaler,

NB

hypokalemia

-
- Pregnancy

2.2 Anticholinergic drug + 2 - agonist Berodual

Inhaler NB Ipratropium bromide

Fenoterol

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-
- Hypokalemia

- Prostate hyperplasia

- Narrow angle glaucoma

- Pregnancy Lactation
- <12

2.3 Methylxanthine (Aminophylline)

acute severe asthma Status

asthmaticus 2-agonist

Budesonide

200 mg/puff

200-1600 mg /

Prednisolone

5 mg/

5-60 mg /

Dexamethasone

4 mg/Amp

5 mg 6

Hydrocortisone

100 mg/vial

1-2 mg/kg

0.5-1 mg/kg

MDI

0.1-2 mg/kg /

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Berodual Forte

Ipratropium 500

(4cc)

mcg Fenoterol

Berodual

Ipratropium 200

Inhaler

1-4 /

125 mcg
mcg

1-8 Puff /

Fenoterol 500
mcg

Salbutamol
Inhaler

Salbutamol NB

Salbutamol 100

1-2 Puff

mcg/puff

4-6

Salbutamol 0.5%

> 12

cc

0.5-1

4-6 < 12

. > 20

4-6

0.5 cc

< 12 . < 20
cc
Salbutamol

2 mg/ 1
2 mg/ 1

4-6

0.25

Dose . 6-8

< 2
2-6

0.1-0.2 mg/kg

0.1-0.2 mg/kg

Max 12mg/day
12 2 mg.

6-

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Max 24mg/day
12 2-4 mg.

>

Max 32mg/day
>70

2 mg.

Max 32mg/day
Seretide

Salmeterol 25

1-4 Puff /day

mg
Fluticasone

50 125 mg
Aminophylline

250 mg/ 10 ml

4 mg./kg/dose

8 ( 250
mg)

1.

Asthma, COPD PEF

Bronchodilator Bronchodilator
PEFR

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2. 1

1.

PEFR
PEFR PEFR
________________

x 100

____

PEFR

2. Chest X-ray

1. Asthma , COPD
Bronchiectasis

2.

Intermittent Persistent

1.
2.

, , 1 /

, , 2 /

3.

PEFR
-

< 80 %

Persistent

ICS ( step 2 )

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-

Intermittent 3

Reliever as needed

Easy Asthma Clinic

Step

1.
2.

3.

4.
5. 80%

Step

1. 2- agonist as needed

Salbutamol Inhaler prn

2. ICS (low dose)

3. ICS (low dose) +

LABA

Budesonide 1

2 Puff / day

Budesonide 1 x 2 + Seretide (25/50)

1

2 P / day

Seretide (25/50) 2 x 2

4. ICS (low dose) +

Seretide (25/50) 2 x 2 + Theophylline

5. ICS (medium dose)

Theophylline

LABA + Xanthine

Seretide (25/125) 2 x 2 +

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+LABA + Xanthine

Budesonide 1 x 2 + Seretide (25/125)

+LABA + Xanthine

Budesonide 2 x 2 + Seretide (25/125)

6. ICS (high dose)

2 x 2 + Theophylline
2 x 2 + Theophylline

Budesonide 3 x 2 + Seretide (25/125)

Step

2 x 2 + Theophylline

7. ICS (high dose)

Budesonide 3 x 2 + Seretide (25/125)

Prednisolone

+Prednisolone dose

+LABA + Xanthine +

2 x 2 + Theophylline

3
Steroid Step
Budesonide 1x1 1

1.
1.1.

Intubation

- Unstable vital signs

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-

Respiratory Rate > 35 /min

-
-
-

Respiratory failure

- Hypoxia = Cyanosis, Air hunger

-

O2 Sat < 95%

- Cardiac or Respiratory arrest

-
-

Secretion obstruction

- 2 agonist

Sat 92 %

NB

O2 6 /min O2

- Dexamethasone 8 mg stat

Prednisolone 6 Tb stat

- IV Fluid

- Lab CXR, CBC, U/A

1.2 Severity
1.
0

1.1 > 5 RR < 30 /

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1

RR

30-40 /

RR > 40 /

RR

1.2 5 RR < 40 /
40-60 /

RR > 60 /

2.
0
1
2

0
1
2

Retraction

Retraction 1

Retraction > 1

3. Wheezing

Expiratory wheezing

Inspiratory Expiratory

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4.

2

5. % O2 Sat

95%

0
1
2

92-94%

91%

2. Scores
1. Total Score 8
-

Salbutamol

NB

Stat

Dexamethasone 8 mg v

Admit Refer

2. Total Score 4-7

-

Stat

Dexamethasone 8 mg
-

Salbutamol

Severity Score
o

Stat

NB

20

Severity Score < 4 D/C

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o
o

Severity Score > 4

Severity Score > 4 3

Admit

3. Total Score < 4

- Prednisolone 6 tab stat

- Salbutamol

20 < 4 D/C

NB

Severity Score

1. Prednisolone 2x3

2.

Antihistamine

3. Antibiotics,

- , ,

- 7-10

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Asthma Severity

Bronchodilator

Bronchodilator

NB Stat

<4

ADMIT

REFER
Discharge

Bronchodilato

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<4
<
Discharge

<
4

Discharge

Bronchodilato

Admit

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