Kerala State Drug Formulary.pdf

Respiratory System
case crystalline penicillin and in the chronic case a broad spectrum
antibiotic such as ampicillin or amoxicillin may be required. Antibiotic therapy
may have to be reviewed when microbiological results are obtained.
Correction of hypoxia: Oxygen is administered with nasal catheter,
or by more effective methods such as masks or tents. If given by nasal
catheter, the rate is 2 to 3 litres per minute and the catheter tip should
be located 15 cm from the nostril. The venturi mask which delivers oxygen
at a preset low concentration is ideal if available.The concentration of
oxygen can be adjusted at 24, 28 or 35% by giving oxygen at rates ranging
from 4 to 8 L/ min. It is desirable to bring the PaO2 level above 50mm Hg and
pH above 7.25. In chronic respiratory failure administration of oxygen
should be closely supervised to avoid the development of carbon dioxide
narcosis.Once the emergency has been tided over, the patient is weaned
off from oxygen gradually.
Supportive measure
If the respiratory failure does not clear up patient may require
more advanced supportive measures such as fluid and electrolyte
administration with monitoring of central venous pressure,assisted ventilation
and so on.This have to be arranged in appropriate centres.
ACUTE SEVERE ASTHMA
Acute exacerbation of asthma can progress on to life threatening
severity if not treated early. Intensification of bronchodilator regimen or a
short course of corticosteroid can abort a life threatening asthma attack.
In most situation patient’s respiratory distress itself is an indicator of severe
asthma attack. The clinical clues are use of accessary muscles of
inspiration,inability to speak continuously pulsus paradoxus and refusal to
recline. If FEV1and PEFR remain less than 40% of the predicted value after
one intense treatment hospitalization is required.
Bronchodilator treatment
Preparations :
1. lnhaled beta agonist - salbutamol / terbutaline 100
mcg 2 puffs every half an hour
2. Nebulizer device (wet aerosol) respirator solution
salbutamol 5 mg / mL; 1 mL + 3 mL saline every 20 - 30
min.
3. I.V. aminophylline 250 mg mixed in 25 mL of 25% glucose
bolus given in 7 - 10 min time repeated 6 h.
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