Sticker

Acute asthmatic attack

Care map

General data: Asthma

Clinical
Spirometry:
Postbronchodilator: FEV1 change >12% and >200 ml;
or PEF increase >20%
PEF variability >20%
Bronchoprovocative test: PC20< 8 mg/ml
Baseline PEF:__________________ L/min
Current medication: dose
ICS:______________________________________________
ICS/LABA:________________________________________
MDI/Evohaler Accuhaler NB
Bronchodilator:____________________________________
Oral drugs:________________________________________
__________________________________________________

Discharge Planning
1. Care giver

2. Vaccination
Influenza vaccine q 1 yr*
**
_________
Pneumococcal vaccine*

_________
3. Education
allergens, pollutants, irritants

4. Smoking cessation

( 8931)

5. ( 9293)


Indication..............
*

_______________________
Date of admission___________________

Assessment of previous clinical control

Characteristic
Daytime symptoms
Limitation of activities

Controlled
Partly controlled
(All of following) (Any presented)
None
>2/weeks
None
Any

Nocturnal symptoms or awaking

None

Any

Need for reliever/rescue inhaler

None

Lung function (PEF or FEV1)

Normal

>2/weeks
< 80%predicted
/personal best

Clinical

Uncontrolled

>3 features
of partly
controlled
asthma

Precipitating factors:
Poor drug compliance Infection Allergen Pollutant
Comorbidities:___________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Severity of asthmatic attack

Mild
Moderate
Severe
Breathless
Walking
Talking
At rest
Talks in
Sentence
Phrase
Word
Respiratory rate
Increased
Increased
> 30 /min
Accessory muscle used No
Yes
Yes
Wheezing
Moderate, expiratory
Loud
Loud
Pulse
< 100 /min
100-120 /min
> 120 /min
PEF
> 80 %
60-80 %
< 60 %
SpO2
> 95 %
91-95 %
< 90%
Diagnosis

Investigation
Initial management before admission
CXR
1. On O2________LPM via ___________ (SpO2 = ______ %)
Parameter

2. Inhaled 2 agonist (Salbutamol, Berodual)

MDI : 4-8 puff q 15-20 min x ________ doses
NB : 4-5 ml q 15-20 min x ________ doses
3. Steroid
Prednisolone oral______mg Dexamethasone IV______ mg
4. Antimicrobial agent
Antibacterial: lactams Macrolides
Respiratory fluoroquinolones Others:___________________
Indication: New infiltration Purulent sputum Others
Antiviral:_________________________________________________
Indication:_______________________________________________

Not done
PEF______L/min
Others:

 admit Day 0 (__/__/__)

Day1 (__/__/__)

Day2 (__/__/__)

Day3 (__/__/__)

Clinical
Vital signs: T____0C, RR_____/min
SpO2___% (on______LPM)
Alert: Yes
No
Talk in: Sentence Phrase Word
Accessory muscles use: Yes No
RS: _________________PEF:_____L/min

Clinical
Vital signs: T____0C, RR_____/min,
SpO2___% (on______LPM)
Alert: Yes
No
Talk in: Sentence Phrase Word
Accessory muscles use: Yes No
RS:_________________PEF:_____L/min

Clinical
Vital signs: T____0C, RR_____/min,
SpO2___% (on______LPM)
Alert: Yes
No
Talk in: Sentence Phrase Word
Accessory muscles use: Yes No
RS:_________________PEF:_____L/min

Clinical
Vital signs: T____0C, RR_____/min,
SpO2___% (on______LPM)
Alert: Yes
No
Talk in: Sentence Phrase Word
Accessory muscles use: Yes No
RS:_________________PEF:_____L/min

Management

Management

Management

Management

Bronchodilator
____________________q______ hr
Corticosteroids
Dexamethasone ____mg IV q ___ hr
Prednisolone_______mg/day
Antibiotic :___________________
oral prednisolone

oral antibiotic

Bronchodilator
____________________q______ hr
Corticosteroids
Dexamethasone ____mg IV q ___ hr
Prednisolone_______mg/day
Antibiotic :___________________
oral prednisolone

oral antibiotic

Bronchodilator
____________________q______ hr
Corticosteroids
Dexamethasone ____mg IV q ___ hr
Prednisolone_______mg/day
Antibiotic :___________________
oral prednisolone

oral antibiotic

Bronchodilator
____________________q______ hr
Corticosteroids
Dexamethasone ____mg IV q ___ hr
Prednisolone_______mg/day
Antibiotic :___________________
D/C
D/C:___________________
Transfer to other ward:____________

Discharge: Day ___ (__/__/__)

PEF prior to discharge:_________ L/min

Home medication:Dose
Controller:_______________________________________________________
Reliever:_________________________________________________________
Corticosteroid:_______________________________________ ( 7 )
Other drugs:_____________________________________________________
____________________________________________________________________
____________________________________________________________________

Appointment:
Asthma clinic OPD Med
Date: ___/___/___
____________________________________________

MDI ( MDI)
1. 4-5
2. 4 2
3.

4. 10 ( 1-10)
5. beta 2 agonist 1 puff 1 puff
corticosteroids
: Treatment steps 1 step