Reflection on Patient with Acute Asthma Management

Acute asthma, for a human body is really harmful. Being from a medical background, I understand the seriousness of the issue and regarding the same I want to add on to my strengths learning better to handle any unwanted situation like that overcoming my weaknesses.

Here, I will discuss all the related important things in understanding the asthma problem and handling a patient quoting an example.

Describe the event or area of learning / knowledge that you identified as part of your clinical scenario

Example: A 45 year old female patient with asthma is to be transferred to FMC. She was initially admitted to a local regional hospital at room no. 0139 with severe asthma issue. As a first step to handle the situation she was being settled with salbutamol and amiophylline. She was then reviewed in the morning time and was suspected with chest infection and congestion. The team of the doctors discussed the issue internally and finally decided to transfer the patient to FMC for further review.

Now what are the challenges and scope of learning areas I found in the case are listed below but for that I want to start from the introduction:-

Acute asthma management is based on some primary steps that include assessing the severity of the patient whether it is mild, moderate, and severe or life threatening. All these will be observed during the startup of the bronchodilator treatment immediately after the patient is being admitted. Next comes the administering oxygen therapy. This is will be observed or implemented if the case is too serious and the therapy is needed to be done. If it is required then there are some things need to keep in mind that saturated oxygen titration to the target or the patient is at 92–95% (adults) or at least 95% (children). After this is done as per the requirement, then comes the number of completing the observations and the assessments that will be solely based on clinical priorities determined by baseline severity. Asthma can be really hazardous for the patient in the longer run, they can cause chronic lung issues and respiratory problems and that is why proper observance and administering is required. Further, keep a close check on systemic corticosteroids within the first hour of treatment is really necessary. Till the time acute asthma gets resolved, a regular and repeated reassessment response to the ongoing treatment is essential. If required the whole process should either be continued or something more should be added to the previous style of treatment. Also, this whole should be repeated in cycle till the patient is transferred or referred to some another hospital or ICU for further observance. Apart from all these, observing the patient for at least 1 hour a day is a must call.

Systemic manifestations and comorbidities of COPD- European Respiratory Journal (2009) European Respiratory Journal – http://erj.ersjournals.com/content/33/5/1165.full.pdf+html

What were you thinking and feeling? Why did you identify the action or leaning as important to you?

It was very shocking as well as sad incident for me as since my childhood I cannot see anybody in pain or in any kind of unwanted situation. To me serving mankind is the ultimate goal for my life. If by chance I could help out anybody during any bad or harmful situation through my efforts, I will be the happiest person on this earth and I mean it. And that is the reason why I chose this medical field at the first place despite of the initial oppose from my family on my decision to get into the medical field as they wanted me to be an architect.

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I believe that you get a chance to be born in the human race just for once, so how will it matter if I don’t become the reason for someone’s happiness. Also, I took this situation really seriously as I wanted to deal with this kind of situation if it occurs further in my family or my neighborhood.

If talking medically, at the first place as per my understanding and learning I thought of giving her salbutamol along with atrovent fused by a nebulizer as a first aid to the issue but then suddenly I planned to delay the same as I came to know that the patient has already taken her daily dose of salbutamol puffer. After having a look on her medical history, I gathered the information that the lady has some anxiety disorder and borderline disorder too. Why I am mentioning these issues here is because of the reason that just due to these disorders, a feeling of shortness of breath can be occurred and at that time I should not be or somebody else for that matter should not be panicked. Apart from these observations, her blood pressure level and heart rate were pretty normal and with these now a proper treatment plan can be taken. Also, for some further added information to the case history, while attending the patient I have observed that in the recent past she has been already admitted to ICU for 3 times and this should be noted down during the treatment plan. During those admissions, she complained of anxiety issues and also that she hates going to the city hospital because of their ICU referral problems. That means she totally hates being admitted in ICU as in ICU the treatment is really complex and hard to adapt.

Heart & Lung- The Journal of Acute and Critical Care (July–August 2012) http://www.sciencedirect.com/science/article/pii/S0147956312000684

Evaluation & Analysis

I would like to list my actions in order of appropriateness.

• What I did well: The Primary survey, observing her social and recent medical history, collecting and placing all the facts related to her health in proper order for further planning, attaching the cardiac monitor with the patient’s body and then closely keep a check on the whether the assessment of heart rhythm respiratory was a thorough one or not
• What I could have done better: I should have given her salbutamol and atrovent nebulizer in the beginning itself, making her feel relax and comfortable by giving her instructions for proper postures, I should have also given more detailed info in handover ISBAR, the call for the second crew support was a big mistake as I could have called the local staff of the hospital itself. I will definitely make a note of these mistakes and will keep in mind for future references
• Also, I could have done a better research on asthmatic patients, the symptoms and the required medical approaches especially for the ones suffering from mental illnesses such as anxiety disorder. Delay in the treatment action plan and decision making was one thing needed to be checked. Apart from these mistakes, one major thing I have learnt is expiratory wheezing can indicate asthma, so I will definitely keep that in mind
• I take all challenges and the situations coming in my path of learning as a positive one, nothing in this world is negative so the positive thing happened with me is that I was finally able to communicate with both partner and patient really well and I am happy about my competence. Opting and deciding the correct clinical approach is another reason for my happiness on my list.

Clinical and economic burden of patients diagnosed with COPD with comorbid cardiovascular disease- Respiratory Medicine (October 2011) http://www.resmedjournal.com/article/S0954-6111(11)00133-8/abstract?cc=y=

What was difficult about the scenario and why?

As a learner or beginner you can say, I think I have a followed a good approach to the whole situation because from the time she was admitted in the hospital, she is feeling much better now. I believe I have applied full and true approaches from my medical learning and understanding in managing the whole situation and for my leadership I would like to add that considering a beginning it was quite good.

I have assessed the vital symptoms and signs of the patient and also have completely referred and observed her past medical history. Not only that during the first step of the treatment, I have linked my approach and planned the treatment as per the history.

If I talk about the difficulties and the barriers that I faced during the situation, then I would like to mention this that English is not my first language and during the treatment procedure I find it really hard to convey my intentions to the patient. Also, I was not able to understand her problems so I need really hard to work on that. Apart from that I believe that learning is a 24X7 process and I will definitely focus on polishing my skills further.

References

Estimating prevalence of common chronic morbidities in Australia-The Medical Journal of Australia (2008)

Estimating prevalence of common chronic morbidities in Australia-The Medical Journal of Australia [Online] Available: https://www.mja.com.au/journal/2008/189/2/estimating-prevalence-common-chronic-morbidities-australia?0=ip_login_no_cache%3Dac017679306e921f901be42b8204e158 [Accessed 3 June 2015]

Clinical and economic burden of patients diagnosed with COPD with comorbid cardiovascular disease- Respiratory Medicine [Online] Available: http://www.resmedjournal.com/article/S0954-6111(11)00133-8/abstract?cc=y= [Accessed 3 June 2015]

Heart & Lung- The Journal of Acute and Critical Care [Online] Available: http://www.sciencedirect.com/science/article/pii/S0147956312000684 [Accessed 3 June 2015]

Systemic manifestations and comorbidities of COPD- European Respiratory Journal [Online] Available: European Respiratory Journal – http://erj.ersjournals.com/content/33/5/1165.full.pdf+html [Accessed 3 June 2015]