Asthma exacerbation resident survival guide: Difference between revisions
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==Management== | ==Management== | ||
==Diagnosis== | |||
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{{Family tree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=''' | {{Family tree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01='''Characterize the symptoms:'''<br> ❑ Dyspnea <br> ❑ Cough <br> ❑ Wheezing <br> ❑ Chest tightness <br> ❑ Reduced exercise tolerance </div>}} | ||
{{Family tree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | {{Family tree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | ||
{{Family tree | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01=''' | {{Family tree | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01='''Examine the patient:''' <br> ❑ Tachypnea <br> ❑ Pulsus paradoxus <br> ❑ Sweating <br> ❑ Central cyanosis <br> ❑ Conjunctival congestion <br> ❑ Prolong end-expiratory wheeze | ||
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❑ O2 saturation <br> ❑ Spirometry'''Initial management'''<br>O2<br>SABA}} | |||
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==Management== | |||
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{{Family tree | | | | | C01 | | | | | | C02 | | | C03 | | | | | | | | | |C01='''Moderate exacerbation'''<br>FEV1/PEF 40-60%<br>Dyspnea with<br> daily activities|C02='''Severe exacerbation'''<br>FEV1/PEF<40%<br>Dyspnea at rest |C03='''Respiratory arrest'''<br> Intubation & mechanical ventilation<br>100%O2<br>SABA & Ipratropium<br>IV corticosteroids }} | {{Family tree | | | | | C01 | | | | | | C02 | | | C03 | | | | | | | | | |C01='''Moderate exacerbation'''<br>FEV1/PEF 40-60%<br>Dyspnea with<br> daily activities|C02='''Severe exacerbation'''<br>FEV1/PEF<40%<br>Dyspnea at rest |C03='''Respiratory arrest'''<br> Intubation & mechanical ventilation<br>100%O2<br>SABA & Ipratropium<br>IV corticosteroids }} | ||
{{Family tree | | | | | |!| | | | | | | |!| | | | |!| | | | | | | | | | |}} | {{Family tree | | | | | |!| | | | | | | |!| | | | |!| | | | | | | | | | |}} |
Revision as of 20:07, 13 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Viral infections
- Exposure to allergen
- Environmental pollutants
- Occupational irritants and sensitizers
- Medications:aspirin
Management
Diagnosis
Characterize the symptoms: ❑ Dyspnea ❑ Cough ❑ Wheezing ❑ Chest tightness ❑ Reduced exercise tolerance | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Examine the patient: ❑ Tachypnea ❑ Pulsus paradoxus ❑ Sweating ❑ Central cyanosis ❑ Conjunctival congestion ❑ Prolong end-expiratory wheeze ❑ O2 saturation ❑ SpirometryInitial management O2 SABA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Management
Moderate exacerbation FEV1/PEF 40-60% Dyspnea with daily activities | Severe exacerbation FEV1/PEF<40% Dyspnea at rest | Respiratory arrest Intubation & mechanical ventilation 100%O2 SABA & Ipratropium IV corticosteroids | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
O2(target>90%sat) Inhaled SABA every 60mins PO corticosteroids | O2(>90%sat) SABA+Ipratropium continuous PO corticosteroids consider adjunct therapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Good response FEV1/PEF>70% No distress Stable after 60 mins of Rx Normal H&P | Incomplete response FEV1/PEF 40-60% Mild-mod symptoms | Poor response FEV1/PEF<40% PCO2≥42 mm Hg Confusion and severe symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Discharge | Admit to ward | Admit to ICU | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Intubation &ventilation IV Corticosteroids SABA[1] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
- SABA:short acting beta agonist
- FEV1:forced expiratory volume for the for the first second
- PEF: Expiratory peak flow
Do's
- In severe exacerbation unresponsive to initial management, consider using IV Mg sulfate
Don'ts
Not recommended medications during hospitalization or emergency care settings
- Methylxanthine
- Antibiotics(except for comorbid conditions)
- Excessive hydration
- Mucolytics
- Chest physical therapy
- Sedation
References
- ↑ National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2007 Aug. Section 5, Managing Exacerbations of Asthma.Available from: http://www.ncbi.nlm.nih.gov/books/NBK7228/