Asthma OSCA

Check for dangers, ensure scene safety. PPE donned

Introduce yourself - name and role

Paediatric Assessment Triangle - assess tone, lookaze, consolability, speech, interactiveness

Identify audible wheeze heard, looks like increased WOB - moderate to severe respiratory distress.

Gain consent to assess and treat from child and mother

Ask patient's name

Position patient upright for easier breathing

Airways - state observations - a) reduced air movement, b) one-word sentences/difficulty speaking, c) silent chest (life-threatening)

Send for ICP - in case of tubing, ventilation and magnesium sulphate

Assess breathing - RATES (AND rhythm) - expose chest

Physical breathing observations - positioning, retraction (intercostal muscles), head bobbing, gasping, grunting, nasal flaring

Oxygen - 15L high-flow non-rebreather

Consider hydrocortisone - check CPM first. Check for general allergies (say "no contraindication"), then confirm severe asthma as a positive indication.

Mention bodyweight calculation (age + 4 x 2). Then mention dose, 4mg/kg IMI. Ampoules come in 100mg to be reconstituted in 2ml saline. Confirm with partner - TREEDEAR - time, reason, education, expiry, documentation, evaluation, assessment, refusal. Administer in shoulder

Salbutamol - check CPM first. Confirm exacerbation of asthma as a positive indication.

After checking CPM, mention dose of nebulised salbutamol, 5mg/2.5ml. Confirm with partner - TREEDEAR - time, reason, education, expiry, documentation, evaluation, assessment, refusal. Administer in neb

Reassess breathing - RATES, physical breathing observations - positioning, retraction (intercostal muscles), head bobbing, gasping, grunting, nasal flaring

Ipatropium bromide - check CPM first. Confirm severe asthma as a positive indication.

After checking CPM, mention dose of nebulised ipatropium bromide, 250microg in 1 x 1ml ampoule (atrovent). Confirm with partner - TREEDEAR - time, reason, education, expiry, documentation, evaluation, assessment, refusal. Administer in neb

Adrenaline - check CPM first. Confirm severe asthma as a positive indication.

After checking CPM, mention dose of IMI adrenaline, 250microg in 1 x 1ml ampoule (atrovent). Confirm with partner - TREEDEAR - time, reason, education, expiry, documentation, evaluation, assessment, refusal. Administer in neb

Assess physical circulation signs - pallor, mottling, waxy appearance, cyanosis, obvious bleeding

Circulation observations - palpate pulses, cap refill, HR, B/P, 4-lead

IV Access - gain consent, 22 gauge cannula, explain procedure

Assess disability - GCS, Temp, BGL, Pupils

Exposure - remove clothes, control for temperature