Asthma exacerbation resident survival guide
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
Dyspnea Cough Wheezing Chest tightness | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initial assessment H&P O2 sat Spirometry Initial management O2 SABA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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
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/