Further Assessment
Assessment:
- The nurse assessing the patient tells you that her saturations have now dropped to 91% on air so she has started supplemental oxygen
What further immediate tests would you do for this patient at this stage?
(choose all that apply)
Well done. You have scored 5 out of 5.
Feedback:
- PEFR:
- if the patient can manage this it will help gauge severity
- NB sometimes the patients are too unwell for this so use your judgement
- CXR:
- Not all exacerbations of asthma need a chest xray, as so often happens when patients are admitted to hospital
- The indications for CXR in the context of asthma are: suspected pneumothorax, suspected consolodation, life-threatening asthma and requirement for ventilation
- This patient now has features of life-threatening asthma so would warrant a chest xray
- ABG:
- An ABG is the most important immediate investigation in this patient
- With these saturations she now has at least one feature of life-threatening asthma and needs urgent investigation and treatment before further deterioration
- ABG is indicated if the Sp02 is less than 92% (on air or supplemental oxygen) or if there are any other signs of life threatening exacerbation as these patients are at risk of hypercapnic respiratory failure and death
- CTPA:
- This does not sound like a PE and the patient is too unwell to make it through the CT scanner
- ECHO:
- Again the patient is too unwell for this test and it does not sound like cardiac failure clinically
