Asthma exacerbation resident survival guide: Difference between revisions
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{{Family tree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01='''Characterize the symptoms:''' }} | {{Family tree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms:''' </div>}} | ||
{{Family tree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | {{Family tree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | ||
{{Family tree | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01='''Examine the patient:''' | {{Family tree | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the patient:''' | ||
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❑ O2 saturation (pulse oximetry) <br> ❑ Spirometry <br> Arterial blood gas (ABG) (PaO<sub>2</sub>/PCO<sub>2</sub>)}} | ❑ O2 saturation (pulse oximetry) <br> ❑ Spirometry <br> Arterial blood gas (ABG) (PaO<sub>2</sub>/PCO<sub>2</sub></div>)}} | ||
{{Family tree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | {{Family tree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | ||
{{Family tree | | | | | | | | | | | | | C01 | | | | | | | | | | | | | | |C01= Classify the severity}} | {{Family tree | | | | | | | | | | | | | C01 | | | | | | | | | | | | | | |C01= Classify the severity}} | ||
{{Family tree | | | | | | |,|-|-|-|^|-|-|^|-|-|-|^|-|-|-|.| | | | | | | |}} | {{Family tree | | | | | | |,|-|-|-|^|-|-|^|-|-|-|^|-|-|-|.| | | | | | | |}} | ||
{{Family tree | | | | | | D01 | | D02 | | | | | D03 | | D04 | | | | | | | | {{Family tree | | | | | | D01 | | D02 | | | | | D03 | | D04 | | | | | | | | ||
D01='''Mild:''' <br> Symptoms: <br> ❑ Breathlessness while walking <br> ❑ Speaks full sentences | D01=<div style="float: left; text-align: left; line-height: 150% ">'''Mild:''' <br> Symptoms: <br> ❑ Breathlessness while walking <br> ❑ Speaks full sentences | ||
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Signs: <br> ❑ Tachypnea <br> ❑ End expiratory wheezing <br> ❑ Pulse < 100/min | Signs: <br> ❑ Tachypnea <br> ❑ End expiratory wheezing <br> ❑ Pulse < 100/min | ||
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❑ FEV<sub>1</sub> ≥ 70% <br> | ❑ FEV<sub>1</sub> ≥ 70% <br> | ||
❑ Pulse oximetry > 95 % <br> | ❑ Pulse oximetry > 95 % <br> | ||
❑ ABG Normal | | ❑ ABG Normal </div>| | ||
D02='''Moderate:''' <br> Symptoms: <br> ❑ Breathlessness at rest, prefers sitting <br> ❑ Speaks phrases <br> ❑ Usually agitated | D02=<div style="float: left; text-align: left; line-height: 150% ">'''Moderate:''' <br> Symptoms: <br> ❑ Breathlessness at rest, prefers sitting <br> ❑ Speaks phrases <br> ❑ Usually agitated | ||
---- | ---- | ||
Signs: <br> ❑ Tachypnea <br> ❑ Using accessory muscles of respiration <br> ❑ Expiratory wheezing <br> ❑ Pulse 100-120/min <br> ❑ Pulsus paradoxus may be present | Signs: <br> ❑ Tachypnea <br> ❑ Using accessory muscles of respiration <br> ❑ Expiratory wheezing <br> ❑ Pulse 100-120/min <br> ❑ Pulsus paradoxus may be present | ||
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❑ ABG: | ❑ ABG: | ||
: PaO<sub>2</sub> ≥ 60 mm Hg | : PaO<sub>2</sub> ≥ 60 mm Hg | ||
: PCO<sub>2</sub> < 42 mm Hg}} | : PCO<sub>2</sub> < 42 mm Hg </div> | | ||
D03=<div style="float: left; text-align: left; line-height: 150% "> </div> | | |||
D04=<div style="float: left; text-align: left; line-height: 150% "> </div>}} | |||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 20:30, 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: | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Examine the patient:
)❑ O2 saturation (pulse oximetry) ❑ Spirometry Arterial blood gas (ABG) (PaO2/PCO2 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Classify the severity | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mild: Symptoms: ❑ Breathlessness while walking ❑ Speaks full sentences Signs: ❑ FEV1 ≥ 70% | Moderate: Symptoms: ❑ Breathlessness at rest, prefers sitting ❑ Speaks phrases ❑ Usually agitated Signs: ❑ FEV1 40-69 %
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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/