Acute asthma access - First Aid

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First aid

First aid

Emergency intervention in children

Sunburn in children Diaper rash Febrile seizures The child who does not sleep Acute asthma access Dental trauma Head injury
  • Sunburn in the child
  • Diaper rash
  • Febrile seizures
  • The child who does not sleep
  • Acute asthma access
    • What causes acute asthma access or an acute bronchospasm crisis in a child
    • How it manifests itself
    • What to do
    • How to administer drugs to the child
    • How much medication to administer and how often
    • When you need to contact your doctor
    • When it is necessary to bring the child to the emergency room
  • Dental trauma
  • Head trauma

Acute asthma access

The episodes of inflammation of the bronchial tubes with intense bronchospasm that simulate an acute access of asthma are very frequent even in the young child (under two years of age). In these children it is not easy to diagnose asthma, therefore, when they have bronchospasm, the pediatrician often says that it is an asthmatic bronchitis (recurrent asthmatic bronchitis when episodes recur). There are many conditions that predispose to bronchospasm, such as being born with a very low weight, premature, or the fact that the airways of the young child have a reduced size. The first episodes of wheezing (bronchospasm) often occur during viral infections of the respiratory tract and even the pediatrician may find it difficult to distinguish if it is really a first episode in an asthmatic child or an obstruction of the bronchi due to inflammation caused by viruses and the small size of the bronchi. The smaller the age of the child who has bronchospasm, the more likely it is not asthma. Only in a minority of children does an asthma-like bronchitis mark the onset of real asthma. In the majority of cases (about 80%), episodes of asthmatic bronchitis disappear or become very rare after 4-5 years. The difficulty in making a precise diagnosis early is mainly linked to the fact that the child cannot collaborate to perform the respiratory function tests (spirometry) which allow to demonstrate that the wheezing disappears after treatment with the so-called bronchodilator drugs (typical situation in case of asthma). There are also no tests to say that bronchospasm is related to viral inflammation.

Children who are more likely to be true asthmatics are those who are familiar with allergy (mom or dad or an allergic brother or sister), suffer from allergic diseases (food allergy, atopic dermatitis), have positive skin tests for some allergens (positive prick tests for egg, milk, mites). The fact that the episodes are very frequent is unfortunately indicative of a greater probability of persistence of asthma at 6 years. In asthma-like bronchitis, due to the effects caused by viral infection and the way the bronchi are made, bronchodilator drugs are not as effective as in true acute asthma access.

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What causes acute asthma access or an acute bronchospasm crisis in a child

The constriction of the muscles surrounding the bronchi, the swelling of the mucous membrane that lines their internal wall and the mucus that fills the space where air usually passes through cause the child a more or less serious difficulty in breathing. It is quite easy to let the air in (inhale), much more difficult to let it out (exhale); the difficulty in letting air out of a contracted bronchus, with the mucous membrane swollen and full of mucus, causes the whistling noise. The air trapped in the lung aggravates the difficulty of breathing.

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How it manifests itself

In young children, coughs may occur which worsen when lying down and prevent them from sleeping and feeding. Usually the breath is short and frequent and observing the chest you can see indentations between one rib and another (the skin seems to be sucked inward with each breath); the same manifestation can be visible in the dimple located at the base of the neck (jugular); hissing noises are heard when you put your ear close to your mouth.

The cough may not even be in very severe accesses. The youngest ones may be inactive, inappetent, agitated, because they struggle to breathe but are unable to understand why or to explain their feelings to parents. Often there is no energy to cry and the child emits a continuous intermittent lament. The older child usually complains of shortness of breath, a sense of weight in the chest and sometimes back pain. It is often difficult for the parent to interpret these symptoms and assess their degree of severity, especially on the occasion of the first episode.

The child who is more than six years old and who already has an asthma diagnosis can be trained in the use of an instrument (peak flow meter) that allows the parent to have a more objective measure of the intensity of the disorder.

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What to do

The first time you find yourself in such a situation, it is essential to contact the pediatrician and, if he is absent, to have recourse to the nearest emergency room.

Subsequently, it is essential that parents are provided with written instructions on how to deal with the problem independently at least in the first moments of access.

In fact, this can also arise quickly and without warning symptoms. The drugs to be used are the same as in adults, i.e. bronchodilators (salbutamol) by inhalation and cortisone taken by mouth. In acute access, inhaled cortisones are not very useful, even if they are widely used (indispensable in the preventive therapy of acute access).

Parents soon become very skilled at recognizing the first signs of acute access: the child is more tired, less active, often has sneezing, an angry cough; after a variable interval more intense cough, feeling of lack of air, whistling may appear. Treatment with inhaled bronchodilator should be started at the first appearance of symptoms that usually signal the onset of acute asthma and protracted access according to the indications of the treating pediatrician.

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How to administer drugs to the child

In acute asthma access for inhalation of bronchodilator drugs, two methods can be used: nebulization with pneumatic aerosol apparatus or dispensing with pre-dosed spray. Both of these methods have limitations and advantages in children.

Pneumatic nebulizers are devices that turn a drug solution into a shower of tiny droplets that can be inhaled into the lungs. They are particularly useful in children because they do not require excessive collaboration and allow high doses of drugs to be dispensed.

The drug, even without coordinated and active breathing, manages to reach the most difficult parts of the lung (bronchioles and alveoli). The drawbacks are that the child must be kept still with the mask well adherent to the face for at least 5 minutes (which is a problem for many parents); moreover, to use them you cannot do without electricity, they must be cleaned very carefully, they are cumbersome to transport.

These last three aspects can represent a real problem if we consider that an asthmatic child should do an activity as normal as possible, made up of outdoor play, trips to the mountains, to the sea, recreational activities away from home with school.

The pre-dosed sprays are a practical and economic way to deliver the drugs in aerosol form; used alone they have some contraindications for the child. The drug is dispensed very quickly (travels at over 100 km / hour) and, if sprayed directly into the mouth, it slams on the walls of the pharynx: in this way the portion of the drug that reaches the lungs is reduced and the side effects increase. The mouthpiece of the can should therefore be kept about 4 cm away from the mouth, but in this way a precise coordination of delivery with inspiration is necessary, which is almost impossible to achieve in a child (it is difficult even for teenagers and adults) .

For this reason, the pre-dosed spray should be used always and only in association with the spacer with mask or mouthpiece, which slows down the speed of the drug particles, especially the larger ones, and reduces side effects.

In the use of the pre-dosed spray with spacer errors can be made with a certain frequency which can significantly affect the amount of drug that reaches the lung. In children under 3 years of age it is useful to insert a mask between the spacer and the mouth, to avoid the dispersion of the drug. The mask must adhere well to the child's face and must cover the nose and mouth as shown in figure 1. Smaller volume spacers are preferable for children under the age of 4, in which a smaller amount of concentrated drug is available greater. Older older children should use bulkier spacers such as the Volumatic and Nebuhaler.

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How much medication to administer and how often

The bronchodilator (salbutamol) should be administered at short intervals in the early stages of acute access. If you are using a dosed spray with a spacer with mask or mouthpiece you can administer 2-4 sprays with a short interval between one spray and another. The series of sprays can be repeated every 20 minutes even for two or three times until the child begins to breathe better, is more relaxed, becomes more lively, the cough becomes less dry and irritating.

If you are using a nebulizer you can make aerosols in close sequence at a dose of 0.6 drops per kg of weight of a 0.5% salbutamol solution, maximum dose 12 drops, diluted in 3 ml of physiological solution. If the child does not improve significantly after 2-3 doses of bronchodilator it is advisable to give him cortisone by mouth (betamethasone 0.1-0.2 mg per kg per day or prednisone 1-2 mg per kg per day). Once the intensity of the symptoms has subsided, the doses of bronchodilator can be spaced, but it should still be administered at least every 3-4 hours on the first day, climbing at 4-6 hours intervals for at least 3-4 days.

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When you need to contact your doctor

  • Always in the first acute asthma access
  • If the crisis does not subside after using the drugs according to the indications
  • If the crisis appears more severe than usual and responds poorly to medications

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When it is necessary to bring the child to the emergency room

  • If the child is apathetic, moves little, speaks little or does not speak at all, he complains constantly, he is unable to lie down and sleep
  • If you are very fatigued from the effort of breathing
  • If it gets worse despite the treatment being done correctly

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